| NPI | 1609821164 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP DOUGLAS THOMPSON Program Director 708-646-5738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 036093462) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 336-008797) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-01-08 |