| NPI | 1629649157 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YESENIA SERVIN Credentialing Mananger 708-979-9082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service |
| Enumeration Date | 2021-07-06 |
| Last Update Date | 2021-07-06 |