| NPI | 1477308815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER SMITH Owner 309-333-9829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-05-13 |