Healthcare Provider Details

I. General information

NPI: 1376698050
Provider Name (Legal Business Name): PSYCHOLOGICAL ASSOCIATES OF CENTRAL ILLINOIS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 SOUTH SIXTH STREET
SPRINGFIELD IL
62703-0406
US

IV. Provider business mailing address

1124 SOUTH SIXTH STREET
SPRINGFIELD IL
62703-0406
US

V. Phone/Fax

Practice location:
  • Phone: 217-523-3143
  • Fax: 217-523-7695
Mailing address:
  • Phone: 217-523-3143
  • Fax: 217-523-7695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: CATHY M TOMLIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 217-523-3143