| NPI | 1184154007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYNISHA CLEGG Director Of Operations 815-758-8616 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 17004) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2023-11-17 |