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General NPI Number Information
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NPI Number | 1639905409
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Entity Type | Organization
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Legal Business Name | JCRX MENTAL HEALTH SERVICES PLLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 1720 BROADWAY ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-2930
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Country | US
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Telephone | 408-656-0623
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Fax |
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Provider Business Mailing Address
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Address Line | 906 MAPLE ST
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City | MOUNT VERNON
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State | IL
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Zip | 62864-3547
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Country | US
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Telephone | 408-656-0623
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA CATHERINE RODRIGUEX WELLMAKER
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Credential | MA, LCPC
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Telephone | 408-656-0623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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