| NPI | 1619448222 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY T BIDWELL Director 815-344-5961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 101Y00000X Counselor |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2019-04-30 |