| NPI | 1467023150 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COREY WENDELL SHUMATE Nurse Practitioner 708-208-4651 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) |
| 251S00000X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2021-11-22 |