| NPI | 1912369364 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKI KNOWLES Business Manager 618-288-8085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 261QM0850X Clinic/Center Adult Mental Health |
| 261QM0855X Clinic/Center Adolescent and Children Mental Health | |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2024-06-14 |