| NPI | 1770291858 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE G LATHAM Owner/Lpc 815-353-1013 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2022-11-08 |