| NPI | 1316534340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER JASPER Owner 224-407-2763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2020-12-23 |
| Last Update Date | 2021-01-12 |