| NPI | 1659696185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELISE D MASSIE Owner 312-228-4200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: IL 071007344) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IL 071007344) |
| Enumeration Date | 2010-03-26 |
| Last Update Date | 2010-03-26 |