| NPI | 1346757721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS R HUMPHREY Owner 847-302-4492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180002680) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI 6501-125) |
| Enumeration Date | 2018-01-06 |
| Last Update Date | 2018-01-16 |