| NPI | 1952678625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA MAHOME Owner 815-521-1889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: IL 036108008) |
| Enumeration Date | 2011-11-24 |
| Last Update Date | 2011-11-24 |