| NPI | 1063724771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY VINEHOUT Clinical Psychologist 815-245-6669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 071006683) |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2010-09-14 |