| NPI | 1912266297 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN MYLES MANION Owner 217-474-8455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IL 180.006836) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180.006836) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2012-05-08 |