| NPI | 1114485158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE STALEY Licensed Clinical Professional Coun 309-287-9722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-03-08 |