| NPI | 1073230165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTINA MARIA WELLS Clinician 618-364-2504 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-10-20 |
| Last Update Date | 2022-10-20 |