| NPI | 1346562881 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY LYNN SASHIDHARAN Treasurer 618-710-4123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.007664) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 018.0007365) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.007775) | |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2012-05-19 |