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110 N. Center Bloomington IL 61701-5002 | |
| (309) 827-0818 | |
| (309) 828-3764 |
| Full Name | |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 110 N. Center, Bloomington, Illinois |
| Authorized Official Name and Position | Michelle M. Matury (DIRECTOR) |
| Authorized Official Contact | 3098270818 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
110 N. Center Bloomington IL 61701-5002 Ph: (309) 827-0818 | 110 N. Center Bloomington IL 61701-5002 Ph: (309) 827-0818 |
| NPI Number | 1528376985 |
|---|---|
| Provider Enumeration Date | 09/20/2010 |
| Last Update Date | 09/20/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528376985 | NPI | - | NPPES |
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