| NPI | 1730871575 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINA VAUGHAN Adminstrative Services Supervisor 618-242-1510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |