| NPI | 1154832913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARYN MICHELLE KONEVICH Owner 872-267-4041 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 149.019494) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2017-10-19 |