| NPI | 1265563381 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE WOODS Business Manager 773-944-5301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071006168) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IN 20041967A) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2020-08-22 |