| NPI | 1538673801 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY ANSARI President 920-698-1886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: IL 180009952) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL 180009952) | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IL 180009952) | |
| Enumeration Date | 2017-11-25 |
| Last Update Date | 2022-12-05 |