| NPI | 1104401454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AVIJIT GHOSH Comptroller 217-333-1202 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2021-03-17 |