| NPI | 1538724364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JACKSON Owner 773-454-7202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2019-05-07 |