| NPI | 1861905051 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARI N MACK Clinical Psychologist 773-307-8148 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: 071.007514) |
| Enumeration Date | 2017-11-09 |
| Last Update Date | 2017-11-09 |