| NPI | 1740825710 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ANN TABOR Owner 815-331-8768 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2019-11-13 |