| NPI | 1255961348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE YVONNE KIBBY-FAGLIER Clinical Neuropsychologist 618-201-8828 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |