| NPI | 1871256453 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ALYSE COSTELLO Registered Agent 312-593-3553 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2021-10-22 |