| NPI | 1467308486 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM NIX-MCCLAIN Chief Program Officer 217-390-0066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2026-03-10 |
| Last Update Date | 2026-03-10 |