| NPI | 1184998692 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORI SPARRY Manager 309-258-8838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 166.000750) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.003547) |
| 1041C0700X Social Worker, Clinical (Licence: IL 149010726) | |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2013-02-12 |