| NPI | 1417792284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA CARRILLO-GUERRERO Owner 773-615-5415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2024-06-25 |
| Last Update Date | 2024-06-25 |