| NPI | 1649970757 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD ROTH Owner 847-340-5785 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-06-22 |