| NPI | 1417453218 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMELIA LEE JUSTICE Clinical Psychologist 815-995-7028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0000X Psychologist Family | |
| 103TP2701X Psychologist Group Psychotherapy | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2018-04-02 |