| NPI | 1649001314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAYNA LONG Owner/Clinician 708-606-1147 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2025-11-12 |