| NPI | 1710610613 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW HICKMAN Manager 309-431-1296 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-07-12 |