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16338 N Il Highway 37 Mount Vernon IL 62864-8178 | |
| (618) 242-1510 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 16338 N Il Highway 37, Mount Vernon, Illinois |
| Authorized Official Name and Position | Kristina Vaughan (ADMINISTRATIVE SERVICES SUPERVISOR) |
| Authorized Official Contact | 6182421510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
16338 N Il Highway 37 Mount Vernon IL 62864-8178 Ph: (618) 242-1510 | 16338 N Il Highway 37 Mount Vernon IL 62864-8178 Ph: (618) 242-1510 |
| NPI Number | 1427794999 |
|---|---|
| Provider Enumeration Date | 05/09/2022 |
| Last Update Date | 05/17/2023 |
| Certification Date | 05/09/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427794999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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