Healthcare Provider Details

I. General information

NPI: 1700053253
Provider Name (Legal Business Name): COLES COUNTY MENTAL HEALTH ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

IV. Provider business mailing address

750 BROADWAY AVE E
MATTOON IL
61938-4610
US

V. Phone/Fax

Practice location:
  • Phone: 217-238-5700
  • Fax: 217-238-5767
Mailing address:
  • Phone: 217-238-5700
  • Fax: 217-238-5767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGIE WILLIAMS
Title or Position: ACCESS CENTER COORDINATOR
Credential: B.A.
Phone: 217-238-5700