| NPI | 1477091908 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA RUDOLPH Owner 815-354-0604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 180007114) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 251S00000X Community/Behavioral Health (Licence: WI 4570125) | |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2025-05-19 |