| NPI | 1346981164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARGARET ULLRICH Therapist 815-953-6924 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2022-04-05 |