| NPI | 1083115760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DUSTIN SUMMERS President 815-735-7588 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 071.009417) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2018-03-17 |