| NPI | 1760647226 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COSME O LOZANO Medical Director 815-729-7790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2016-07-13 |