| NPI | 1508460700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMANUEL GONZALEZ Licensed Clinical Psychologist 815-676-4688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TH0004X Psychologist Health | |
| Enumeration Date | 2020-11-28 |
| Last Update Date | 2020-11-28 |