| NPI | 1326282401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN JEAN HANCE Billing Clerk 217-323-2980 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2009-04-21 |
| Last Update Date | 2020-03-10 |