| NPI | 1477011310 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNADETTE MIETUS STEVENSON Owner 224-361-3301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2023-04-23 |