| 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 |