| NPI | 1689296162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE KAUFMAN Interstate Services Supervisor 773-561-6196 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-05-07 |