| NPI | 1750888202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LYN MCKINNEY Owner 815-263-0919 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: IN 20043000A) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |