| NPI | 1619377637 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRISY MARIE GOWAN President 815-503-9018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.007379) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2014-08-27 |