| NPI | 1609151158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L. STREETS GLADWIN Owner 309-507-1791 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 001200) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |