| NPI | 1578303426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA VOS Manager 815-315-2863 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2024-05-29 |