| NPI | 1841995644 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA PETTY Lpc 773-906-6690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-06-19 |