| NPI | 1730656000 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLIE RYAN STOCK Owner 773-726-7290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2019-03-25 |