| NPI | 1104378579 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL ADAM BURASH Counselor 815-343-5691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL A75150001A) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2016-11-01 |