| NPI | 1467476895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID TKACH CEO 217-545-7578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional | |
| 103G00000X Clinical Neuropsychologist | |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist Clinical | |
| 1041C0700X Social Worker Clinical | |
| 2084N0402X Psychiatry & Neurology Neurology with Special Qualifications in Child Neurology | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-07-21 |