| NPI | 1942916572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY L WILKES CEO 773-437-7816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2026-05-13 |