| NPI | 1972940542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL C MARTINEZ Clinical Director 773-234-8133 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 180008233) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180008233) |
| 101YM0800X Counselor, Mental Health (Licence: IL 180008233) | |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2013-05-22 |