Healthcare Provider Details

I. General information

NPI: 1467939710
Provider Name (Legal Business Name): DUSTUN E RHEA MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DEVONSHIRE DR STE B16-18
CHAMPAIGN IL
61820-7337
US

IV. Provider business mailing address

701 DEVONSHIRE DR STE B16-18
CHAMPAIGN IL
61820-7337
US

V. Phone/Fax

Practice location:
  • Phone: 217-531-2360
  • Fax: 217-352-2635
Mailing address:
  • Phone: 217-531-2360
  • Fax: 217-352-2635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: