| NPI | 1710611702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN TELFORD Owner 773-453-6112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist | |
| 103TC0700X Psychologist, Clinical | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2022-07-14 |