| NPI | 1669709648 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN A SMITH Clinician 815-285-3073 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178006336) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2009-11-11 |