| NPI | 1720501646 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LOUIS V HAYNES Executive Director 773-250-1769 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0801X (Licence: IL 180.008602) |
| Enumeration Date | 2017-07-23 |
| Last Update Date | 2019-08-05 |