| NPI | 1598387813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANEQUA BLAKELY Owner 815-222-1137 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2020-05-08 |
| Last Update Date | 2020-05-26 |