| NPI | 1144937541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN MOORE Practice Manager 224-406-3556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2024-10-02 |