| NPI | 1568907616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA LANGLEY Clinical Supervisor 309-645-5445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.008564) |
| Enumeration Date | 2016-12-28 |
| Last Update Date | 2016-12-28 |