Healthcare Provider Details

I. General information

NPI: 1053603977
Provider Name (Legal Business Name): MENTAL HEALTH CENTERS OF WESTERN ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 RANDOLPH ST BLDG D
CARTHAGE IL
62321-1266
US

IV. Provider business mailing address

700 SE CROSS ST
MOUNT STERLING IL
62353-1561
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-3325
  • Fax: 217-773-2425
Mailing address:
  • Phone: 217-773-3325
  • Fax: 217-773-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: KATIE WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC
Phone: 217-773-3325