| NPI | 1376009753 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY FISHER Finance Director 815-338-3590 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-04-27 |