| NPI | 1265970180 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISSY L WILSON Office Manager 815-621-1932 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 149015073) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2017-02-11 |