| NPI | 1750439444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY LEE Practice Manager 866-296-5262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 149-001769) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 149-002088) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2025-04-03 |