| NPI | 1356214084 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM JACKSON Owner 618-924-5633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-09-29 |
| Last Update Date | 2025-09-29 |