| NPI | 1144802521 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN WILLIAM SCHLOER Member 224-421-6235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2021-04-25 |
| Last Update Date | 2024-03-08 |