| NPI | 1629825658 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WELDLER Manager 773-919-9351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-08-21 |