| NPI | 1205213758 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN LESLIE FRESHOUR President 309-261-6129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: IL 180.009588) |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2024-01-05 |