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5310 E William Street Rd Decatur IL 62521-1874 | |
| (217) 422-6361 | |
| (217) 422-6365 |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5310 E William Street Rd, Decatur, Illinois |
| Authorized Official Name and Position | Jeremy Ray Maupin (PRESIDENT) |
| Authorized Official Contact | 2174226361 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
5310 E William Street Rd Decatur IL 62521-1874 Ph: (217) 422-6361 | 5310 E William Street Rd Decatur IL 62521-1874 Ph: (217) 422-6361 |
| NPI Number | 1104291905 |
|---|---|
| Provider Enumeration Date | 12/04/2015 |
| Last Update Date | 12/04/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104291905 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 149.016196 (Illinois) | Primary |
A & E Behavioral Health Care Associates Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 2570 Federal Drive, Decatur, IL 62526 Phone: 217-872-1003 Fax: 217-233-4150 | |
Armor Bearer Services Inc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 861 W William St, Decatur, IL 62522 Phone: 217-402-4226 | |
Decatur Psychological Associates Pc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 3040 N University Ave, Suite 2, Decatur, IL 62526 Phone: 217-872-1700 Fax: 217-872-1366 |