Healthcare Provider Details

I. General information

NPI: 1336089192
Provider Name (Legal Business Name): 101 WAYS NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 CAMP JACKSON RD
CAHOKIA HEIGHTS IL
62206-2202
US

IV. Provider business mailing address

1313 CAMP JACKSON RD
CAHOKIA HEIGHTS IL
62206-2202
US

V. Phone/Fax

Practice location:
  • Phone: 618-515-5004
  • Fax: 618-515-5144
Mailing address:
  • Phone: 618-515-5004
  • Fax: 618-515-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ANDREWS
Title or Position: CEO
Credential: CHW
Phone: 618-799-7314