| NPI | 1730655317 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLIVIA R TORRES Psychologist Resident 309-208-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2018-10-25 |