| NPI | 1528822731 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH SEELOW Credentialing Coordinator 815-650-0886 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2024-02-09 |