| NPI | 1104926625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICAH K SWANSEY Executive Director 708-747-0981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071006944) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2008-10-30 |