Healthcare Provider Details

I. General information

NPI: 1235663949
Provider Name (Legal Business Name): HERITAGE BEHAVIORAL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 SUNRISE CT
CLINTON IL
61727-9906
US

IV. Provider business mailing address

151 N MAIN ST
DECATUR IL
62523-1206
US

V. Phone/Fax

Practice location:
  • Phone: 217-362-6262
  • Fax: 217-362-6290
Mailing address:
  • Phone: 217-362-6262
  • Fax: 217-362-6290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARY GARRISON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 217-362-6262