| NPI | 1245507573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN HURD Behavioral Health Tech 1708-681-0073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 261QM08o1x) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2011-12-01 |