MEDICARE: COMPREHENSIVE MENTAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	320800000X	Mental Illness Community Based Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679742506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE MENTAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.

Provider Business Mailing Address
First Line	:	505 S 8TH ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62201-2919
Country	:	US
Telephone Number	:	618-482-7330
Fax Number	:	618-482-4351

Provider Business Practice Location Address
First Line	:	1501 S G ST
Second Line	:
City	:	EAST SAINT LOUIS
State	:	IL
Zip	:	62207-2057
Country	:	US
Telephone Number	:	618-482-7330
Fax Number	:	618-482-4351

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JOSEPH J HARPER
Credential	:	LCSW, MBA, CADC
Telephone Number	:	618-482-7330

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	07/12/2023

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