| NPI | 1073024576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE MIROCHA Therapist 815-676-4688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 149017464) |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2017-10-24 |