| NPI | 1679257539 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILLIP SQUIBB Authorized Official 618-267-6121 |
| Organization Subpart ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101Y00000X Counselor |
| 103T00000X Psychologist | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |