| NPI | 1528570868 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARLY MOUNT Director Or Clinical Operations 773-320-2907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810005487) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2017-10-26 |