| NPI | 1699430967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER L KIEBLES Owner 773-895-7490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2021-11-02 |
| Last Update Date | 2021-11-02 |