| NPI | 1700342813 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY CHRISTINE THOMAS Administrator 309-838-1888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2019-02-13 |
| Last Update Date | 2019-02-13 |