| NPI | 1659269231 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAYLE LANE Licensed Clinical Professional Coun 815-412-5765 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2025-06-24 |