| NPI | 1104399682 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES JORGENSON Executive Director 630-801-1669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 2251S0007X Physical Therapist, Sports | |
| Enumeration Date | 2019-01-07 |
| Last Update Date | 2019-01-07 |