| NPI | 1962010330 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY MIKA Clinical Psychologist 708-433-9582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2020-07-21 |