| NPI | 1922326875 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROLYN SUE VAN DOREN Director 815-284-6111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: IL 071.007278) |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: IL 071.007278) |
| Enumeration Date | 2010-05-16 |
| Last Update Date | 2012-03-01 |