| NPI | 1679010771 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GONCHIGARI NARAYANA Owner 309-764-5040 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: IL 336.042316) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: IL 180.006915) |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2017-01-26 |