| NPI | 1518105055 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AIMEE MICETIC Owner 815-274-3416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.006068) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2011-01-05 |