| NPI | 1720368608 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA PICKERING Computer Billing 618-658-2611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) (Licence: IL 04055) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2011-08-23 |