| NPI | 1639933732 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA OLSON Practice Owner 815-200-1099 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 101YP2500X Counselor, Professional | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2024-02-08 |
| Last Update Date | 2025-08-20 |