| NPI | 1679937460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELANIE HOOGSTRAAT Credentialing Specialist 217-398-9066 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180.004442) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2025-07-30 |