| NPI | 1295113330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY WEEMS Chief Executive Officer 888-205-5532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 15001) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: IL 15001) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: IL 15001) | |
| 103TC0700X Psychologist, Clinical (Licence: IL 15001) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: IL 15001) | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2017-05-03 |