| NPI | 1699631929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN D COKLOW Compliance Officer 773-597-7698 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2026-04-03 |