| NPI | 1659066066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY VINEHOUT Owner / CEO 815-245-6669 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103TC0700X Psychologist, Clinical | |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2024-05-02 |