| NPI | 1811412166 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL WAYNE HICKS Principal, Licensed Clinical Psych 630-849-8275 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-04-28 |