| NPI | 1235796061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNY LEMUS Licensed Counselor 773-656-2102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |