| NPI | 1659549632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAULINE ROCHFORT Billing Director 847-695-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2020-07-20 |