| NPI | 1659047744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KORY L MAY CEO/President 618-741-9635 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 101YM0800X Counselor, Mental Health | |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| 106H00000X Marriage & Family Therapist | |
| 163WP0200X Registered Nurse, Pediatrics | |
| 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 405300000X Prevention Professional | |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-10-29 |