| NPI | 1447538160 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VERED DOR Owner 847-980-8707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007907) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 071007907) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2012-02-21 |