| NPI | 1093423790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANISHA HINES Administrator 773-569-0791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2023-05-12 |