| NPI | 1356152169 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA OLUSOLA Manager 708-879-2975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-01-20 |
| Last Update Date | 2025-08-21 |