| NPI | 1407594120 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY HUELSMANN CEO 618-213-8705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 253J00000X Foster Care Agency | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2022-05-23 |