| NPI | 1386969533 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY PHILLIPS Billing Manager 618-937-6483 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2010-03-31 |
| Last Update Date | 2021-03-17 |