| NPI | 1366935884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI LARAE GRISWOLD Psychotherapist 815-782-0210 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 180.010917) |
| Enumeration Date | 2018-06-09 |
| Last Update Date | 2018-07-27 |