| NPI | 1568949329 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE DZADO Admin 312-372-6707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-07-25 |
| Last Update Date | 2020-04-20 |