| NPI | 1942490438 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN STAHL Billing Specialist 224-426-5852 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health (Licence: WI 1730) |
| Additional Taxonomies | 251S00000X (Licence: WI 1730) |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: WI 1730) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2021-02-25 |