| NPI | 1629480587 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER TABOR Owner/Therapist 815-529-5933 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 149.011675) |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2014-05-27 |
| Last Update Date | 2020-05-05 |