| NPI | 1568591782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY VINEHOUT Clinical Psychologist 815-245-6669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: IL 071-006683) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180-006526) |
| 103TC0700X Psychologist Clinical (Licence: IL 071-006683) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-06-30 |