| NPI | 1396067559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA JO ELLIOTT Manager/Owner 309-212-3606 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 180004957) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 1041C0700X Social Worker, Clinical | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2023-01-23 |