| NPI | 1164315511 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE R COCKRELL Executive Director, Counselor 217-530-0147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-02 |
| Last Update Date | 2025-06-02 |