NPI | 1730231135 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT LEON JACKSON Psychologist President 217-793-2770 |
Organization Subpart ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071001761) |
Enumeration Date | 2007-01-17 |
Last Update Date | 2020-08-22 |