| NPI | 1588789994 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA L LANE Practice Manager 630-416-8289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: IL 149011145) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2008-05-02 |