| NPI | 1720714702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE M KASPER Practice Manager 847-854-4333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2022-09-23 |