| NPI | 1821153206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES KENTON MATTOX Director Counselor 618-997-2129 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149002548) |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2020-08-22 |