| NPI | 1669019212 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA BECHARD Billing And Claims Specialist 217-323-2980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2020-03-10 |