| NPI | 1710162862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES TRIPP Administrator 773-510-6165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP2701X Psychologist, Group Psychotherapy (Licence: IL 036100974) |
| Enumeration Date | 2008-01-08 |
| Last Update Date | 2008-01-08 |