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General NPI Number Information
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NPI Number | 1164730925
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Entity Type | Organization
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Legal Business Name | MACON COUNTY COMMUNITY MENTAL HEALTH BOARD
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 09/15/2010
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Provider Practice Location Address
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Address Line | 132 S WATER ST SUITE 604
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City | DECATUR
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State | IL
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Zip | 62523-1332
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Country | US
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Telephone | 217-423-6199
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Fax |
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Provider Business Mailing Address
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Address Line | 132 S WATER ST SUITE 604
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City | DECATUR
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State | IL
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Zip | 62523-1332
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Country | US
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Telephone | 217-423-6199
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DENNIS CROWLEY
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Credential |
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Telephone | 217-423-6199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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