| NPI | 1881973238 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY BAUER MIS Coordinator 618-282-6233 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |