| NPI | 1972780880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP A BURKE Sole Member 618-527-6144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007221) |
| Enumeration Date | 2008-01-23 |
| Last Update Date | 2010-04-22 |