| NPI | 1194425702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRITTON CARLSON Director 815-387-5664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |