| NPI | 1538288402 |
|---|---|
| Doing Business As | SCOTT COSTELLO |
| Entity Type | Organization |
| Authorized Contact | SCOTT COSTELLO Owner 815-806-9300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2011-09-13 |