| NPI | 1598361651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERANN IVY Apn 312-285-2982 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2020-12-04 |
| Last Update Date | 2021-02-17 |