| NPI | 1871984534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY KARVINEN Owner 618-659-5411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180003528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 15725) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 19943) | |
| 101YM0800X Counselor, Mental Health (Licence: IL 178000692) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2015-02-16 |