| NPI | 1629002662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD HARLOW Client Services/Billing Specialist 847-933-0051 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2018-04-06 |