| NPI | 1982435657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE LYNN GARLAND CFO 815-780-7110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2024-08-13 |
| Last Update Date | 2024-10-15 |