Healthcare Provider Details

I. General information

NPI: 1124250402
Provider Name (Legal Business Name): DUI SOLUTIONS & TREATMENT ALTERNATIVES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WEST JEFFERSON STREET SUITE 501
BLOOMINGTON IL
61701
US

IV. Provider business mailing address

207 W JEFFERSON ST SUITE 501
BLOOMINGTON IL
61701-3960
US

V. Phone/Fax

Practice location:
  • Phone: 309-828-1988
  • Fax: 309-828-6540
Mailing address:
  • Phone: 309-828-1988
  • Fax: 309-828-6540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.002048
License Number StateIL

VIII. Authorized Official

Name: MR. RICHARD W. MAST
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: CADC, NCAC II, CCJS
Phone: 309-828-1988