| NPI | 1902203540 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES ALLEN WEBSTER System Support Specialist 708-907-1583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health | |
| 101YP2500X Counselor, Professional | |
| 104100000X Social Worker | |
| 1041C0700X Social Worker, Clinical | |
| 106H00000X Marriage & Family Therapist | |
| 253J00000X Foster Care Agency (Licence: IL 012998-11) | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2022-11-11 |