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NPI Code Detail

MEDICARE: MOULTRIE COUNTY MENTAL HEALTH CENTER

MEDICARE: MOULTRIE COUNTY MENTAL HEALTH CENTER
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
1101YA0400XAddiction (Substance Use Disorder) CounselorA-0043-0002-AIL
2101YM0800XMental Health Counselor04105IL
3101YP2500XProfessional Counselor180.005810IL
4101YP2500XProfessional Counselor178.004724IL
5101YP2500XProfessional Counselor180.003537IL
61041C0700XClinical Social Worker149.011051IL
7261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)36052881IL
8251S00000XCommunity/Behavioral Health Agency04105IL

General Provider Information

NPI Number : 1811025240
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOULTRIE COUNTY MENTAL HEALTH CENTER
Provider Business Mailing Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Provider Business Practice Location Address
First Line : 12 W HARRISON ST
Second Line :
City : SULLIVAN
State : IL
Zip : 61951-1907
Country : US
Telephone Number : 217-728-4358
Fax Number : 217-728-2270
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DAVID L. COLE
Credential : MSW, LCSW
Telephone Number : 217-728-4358
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/25/2016

Similar Medicare Providers

1164660775 — DAVID L COLE LCSW, LPHA
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1225564792 — MS. TABITHA MCMICHAEL MA, LCPC
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1063999241 — LISA V THOMAS
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1073090270 — PENNY ARLENE ARTHUR
Practice Location Address:
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1881171064 — MRS. PAMELA SUE LAWYER LPN/MHP
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Practice Fax:

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