Organization
WOLF LARSON ENTERPRISES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GIBB LCPC (OWNER)
(309) 208-1288
Entity
Organization
Contact information
Practice address
1932 DEER LN, WASHINGTON, IL 61571-9679
(309) 208-1288
Mailing address
1932 DEER LN, WASHINGTON, IL 61571-9679
(309) 208-1288
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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