| NPI | 1588373674 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MEGHAN BASH Practice Administrator 309-263-5565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2022-11-17 |