| NPI | 1356648539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY J BEISEL Licensed Clinical Professional Coun 618-580-5708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.1004316) |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2016-01-08 |