| NPI | 1154183267 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN ROCHON Owner 815-529-5933 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-01-24 |
| Last Update Date | 2025-01-14 |