| NPI | 1295511939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDEN FASKEN Vice President 815-780-0690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2024-04-17 |