Healthcare Provider Details

I. General information

NPI: 1891856795
Provider Name (Legal Business Name): ASSOCIATES IN MENTAL HEALTH, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 MAIN ST SUITE 580
PEORIA IL
61602-1005
US

IV. Provider business mailing address

900 MAIN ST SUITE 580
PEORIA IL
61602-1005
US

V. Phone/Fax

Practice location:
  • Phone: 309-637-4266
  • Fax: 309-637-9836
Mailing address:
  • Phone: 309-637-4266
  • Fax: 309-637-9836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRADFORD EMIL COLEN
Title or Position: PARTNER
Credential: MD
Phone: 309-637-4266