NPI | 1528457835 |
---|---|
Entity Type | Organization |
Authorized Contact | KELLY LYNNE CANAVAN Owner/Clinical Director 815-979-2580 |
Organization Subpart ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180.009124) |
Enumeration Date | 2015-01-10 |
Last Update Date | 2023-08-16 |