| NPI | 1760246201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMANTHA JANE DALLAS Owner 815-474-3380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-02-06 |
| Last Update Date | 2024-11-08 |