| NPI | 1396157939 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA WELLS Director 312-489-4715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy |
| Additional Taxonomies | 347C00000X Private Vehicle |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2014-06-02 |