| NPI | 1215574496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY BARSHELL KETCHUM CAO,Administrator 708-277-8673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0040X Psychiatry & Neurology Behavioral Neurology & Neuropsychiatry |
| Enumeration Date | 2019-12-05 |
| Last Update Date | 2019-12-05 |