| NPI | 1194410886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORA WIENS Co Owner 224-655-0031 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-06-07 |