| NPI | 1669032520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH G WILSON Director 312-801-6219 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2019-06-13 |