| NPI | 1588038780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATHARINE MARTIN Provider 217-717-4399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180-004787) |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2016-01-07 |