| NPI | 1942471529 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMIE RENEE WAGNER Owner 815-601-4673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180033993) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2020-09-24 |