| NPI | 1295247518 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MASZAK Founder 331-216-3363 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 14901765) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IL 14901765) |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL 14901765) | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2022-03-23 |