| NPI | 1649917345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JISELLE ROMAN Licensed Clinical Professional Coun 773-627-7914 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 251S00000X |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2023-11-04 |