| NPI | 1356111090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRYD EDWARD MCGUIRE Nurse Practitioner 815-408-0988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2024-01-04 |
| Last Update Date | 2024-08-07 |