| NPI | 1902407547 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW DUTTON Initial Member 217-417-1059 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 251S00000X | |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2020-11-02 |