Healthcare Provider Details

I. General information

NPI: 1245233493
Provider Name (Legal Business Name): MCLEAN COUNTY CENTER FOR HUMAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W MARKET ST
BLOOMINGTON IL
61701-3918
US

IV. Provider business mailing address

108 W MARKET ST
BLOOMINGTON IL
61701-3918
US

V. Phone/Fax

Practice location:
  • Phone: 309-827-5351
  • Fax: 309-829-6808
Mailing address:
  • Phone: 309-827-5351
  • Fax: 309-829-6808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS BARR
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 309-827-5351