| NPI | 1851314918 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA JONES Business Manager 618-939-4444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL N/A) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-11-26 |