| NPI | 1114351947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGAN MARIE TAYLOR Managed Care Supervisor 888-927-3786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: IL 04023) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2021-02-25 |