Healthcare Provider Details

I. General information

NPI: 1679742506
Provider Name (Legal Business Name): COMPREHENSIVE MENTAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S G ST
EAST SAINT LOUIS IL
62207-2057
US

IV. Provider business mailing address

505 S 8TH ST
EAST SAINT LOUIS IL
62201-2919
US

V. Phone/Fax

Practice location:
  • Phone: 618-482-7330
  • Fax: 618-482-4351
Mailing address:
  • Phone: 618-482-7330
  • Fax: 618-482-4351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH J HARPER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, MBA, CADC
Phone: 618-482-7330