| NPI | 1972294197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKI KNOWLES Business Manager 618-288-8085 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2023-05-18 |
| Last Update Date | 2024-07-19 |