| NPI | 1992559389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANCEY WICKSTROM Manager 773-510-4018 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2024-04-12 |
| Last Update Date | 2024-04-12 |