| NPI | 1376360552 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY D PHILLIPS Ar Director 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-09-20 |
| Last Update Date | 2024-09-20 |