Healthcare Provider Details

I. General information

NPI: 1457013765
Provider Name (Legal Business Name): COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S 8TH ST
EAST SAINT LOUIS IL
62201-2919
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: 618-274-6437
Mailing address:
  • Phone: 618-482-7330
  • Fax: 618-274-6437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSPEH HARPER
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW, MBA, CADC
Phone: 618-482-7330