| NPI | 1346436672 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERI DEAN BOUDREAU Licensed Clinical Professional Coun 815-929-1940 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180003442) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2009-12-10 |