| NPI | 1568949865 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE ANN DECKARD-TANKERSLEY Managing Partner/Owner 773-733-6629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY10079) |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2018-07-19 |