| NPI | 1962144279 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CASEY PERISIN Owner 847-951-4366 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center Adult Mental Health |
| Additional Taxonomies | 261QM0855X Clinic/Center Adolescent and Children Mental Health |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-04-08 |