| NPI | 1144191651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTNEY LOPEZ Manager 815-276-4976 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist, Cognitive & Behavioral | |
| Enumeration Date | 2025-09-16 |
| Last Update Date | 2025-09-16 |