Healthcare Provider Details

I. General information

NPI: 1922373968
Provider Name (Legal Business Name): THE CENTER FOR YOUTH & FAMILY SOLUTIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N CENTER ST
BLOOMINGTON IL
61701-2981
US

IV. Provider business mailing address

603 N CENTER ST
BLOOMINGTON IL
61701-2981
US

V. Phone/Fax

Practice location:
  • Phone: 309-829-6307
  • Fax: 309-829-3254
Mailing address:
  • Phone: 309-829-6307
  • Fax: 309-829-3254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number512961
License Number StateIL

VIII. Authorized Official

Name: ANTHONY RIORDAN
Title or Position: CHEIF OPERATING OFFICER
Credential: LMFT
Phone: 309-671-5700