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