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General NPI Number Information
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NPI Number | 1689313082
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Entity Type | Organization
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Legal Business Name | T H MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 06/02/2022
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 2041 W ILES AVE STE C
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City | SPRINGFIELD
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State | IL
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Zip | 62704-7006
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Country | US
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Telephone | 217-553-0266
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Fax |
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Provider Business Mailing Address
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Address Line | 7011 PRESTON DR
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City | SPRINGFIELD
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State | IL
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Zip | 62711-4310
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Country | US
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Telephone | 217-553-0266
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Fax |
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Authorized Official
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Title or Position | ADMISTRATOR
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Name | OMOTOLA WASILAT DANMOLE-ODIMAYO
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Credential | PMHNP
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Telephone | 217-553-0266
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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