| NPI | 1457035677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER KOONTZ Co Owner 618-367-2138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2023-06-09 |
| Last Update Date | 2023-06-09 |