| NPI | 1285836247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DALE BURKHARDT Practice Manager 708-364-7046 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 103TC0700X Psychologist Clinical |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2020-08-22 |