| NPI | 1497036321 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARA BEANBLOSSOM Licensed Clinical Psychologist 312-385-9777 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.006369) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2015-07-13 |