| NPI | 1093480592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY TANNER Managing Owner 847-849-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2021-08-16 |