| NPI | 1205570843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE YATES Owner 815-846-0684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2022-06-15 |