| NPI | 1790310159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROY C REESE President CFO 773-717-9921 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 282J00000X Religious Nonmedical Health Care Institution | |
| Enumeration Date | 2020-03-05 |
| Last Update Date | 2020-03-05 |