| NPI | 1861776213 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACI DANNER Billing Manager 309-344-2323 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: IL 04016) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 04016) |
| 101YM0800X Counselor, Mental Health (Licence: IL 04016) | |
| 101YP2500X Counselor, Professional (Licence: IL 04016) | |
| 104100000X Social Worker (Licence: IL 04016) | |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2011-11-30 |