| NPI | 1245051986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA LAFOLLETTE Credentialing Rep 309-883-0908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2024-10-23 |
| Last Update Date | 2024-10-23 |