| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2710 17th St, Zion, Illinois |
| Authorized Official Name and Position | Pat Davenport (CEO) |
| Authorized Official Contact | 8477317165 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2710 17th St Zion IL 60099-1543 Ph: (847) 731-7165 | 2710 17th St Zion IL 60099-1543 Ph: (847) 731-7165 |
| NPI Number | 1336781293 |
|---|---|
| Provider Enumeration Date | 10/11/2019 |
| Last Update Date | 12/06/2023 |
| Certification Date | 12/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336781293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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