| NPI | 1164125621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LINDSAY KEISMAN Director 815-236-3272 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-03-23 |