| NPI | 1336095785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY DEAN Owner 773-616-9162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2026-03-09 |
| Last Update Date | 2026-07-21 |