| NPI | 1154099018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA WINKLER Owner 217-203-1573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2021-09-03 |