| NPI | 1316401011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY NICHOLS Owner/Therapist 217-417-1701 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YP2500X Counselor Professional | |
| Enumeration Date | 2019-01-26 |
| Last Update Date | 2019-01-26 |