| NPI | 1669177788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW VAIL Clinical Social Worker 312-600-7874 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103T00000X Psychologist | |
| Enumeration Date | 2023-03-31 |
| Last Update Date | 2023-03-31 |