| NPI | 1467872820 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE POTTER C0 Owner 224-535-9555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 251S00000X (Licence: IL 00) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2022-07-21 |