| NPI | 1699439869 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIA CLEMENTS Owner 217-454-6113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 103T00000X Psychologist | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TF0000X Psychologist, Family | |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2022-01-31 |