| NPI | 1447874664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY DIMAS Billing Specialist 224-422-9760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2020-06-03 |
| Last Update Date | 2020-06-03 |