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NPI Code Detail

MEDICARE: COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.

MEDICARE: COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251C00000XDevelopmentally Disabled Services Day Training Agency
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255500377
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Provider Business Mailing Address
First Line : 505 S 8TH ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62201-2919
Country : US
Telephone Number : 618-482-7330
Fax Number :
Provider Business Practice Location Address
First Line : 505 S 8TH ST
Second Line :
City : EAST SAINT LOUIS
State : IL
Zip : 62201-2919
Country : US
Telephone Number : 618-482-7330
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : JOSEPH HARPER
Credential : LCSW, MBA, CADC
Telephone Number : 618-482-7330
Provider Enumeration Date : 02/22/2008
Last Update Date : 07/12/2023

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Practice Fax: 618-274-6437

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