| Locust Street Resource Center | |
|
320 South Locust Street Carlinville IL 62626 | |
| (217) 854-3166 | |
| (217) 854-9729 |
| Full Name | Locust Street Resource Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 320 South Locust Street, Carlinville, Illinois |
| Authorized Official Name and Position | Maria Clark (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2178543166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Locust Street Resource Center 320 South Locust Street Carlinville IL 62626 Ph: (217) 854-3166 | Locust Street Resource Center 320 South Locust Street Carlinville IL 62626 Ph: (217) 854-3166 |
| NPI Number | 1558456210 |
|---|---|
| Provider Enumeration Date | 10/04/2006 |
| Last Update Date | 10/24/2024 |
| Certification Date | 10/24/2024 |
| Medicare PECOS PAC ID | 6002846599 |
|---|---|
| Medicare Enrollment ID | O20050815000615 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558456210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Raymond S Bland |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1881653103 PECOS PAC ID: 3678475894 Enrollment ID: I20040127000139 |
| Provider Name | Juan M Medina |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1265485106 PECOS PAC ID: 1153351648 Enrollment ID: I20050815000651 |
| Provider Name | Vinod Alluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548279870 PECOS PAC ID: 1254336357 Enrollment ID: I20060925000093 |
| Provider Name | Seleena Meher Shrestha |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1902043334 PECOS PAC ID: 1759508955 Enrollment ID: I20140812001834 |
| Provider Name | Kimberley A Durr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093114290 PECOS PAC ID: 1052615325 Enrollment ID: I20160205002011 |
| Provider Name | Carmen Orellana Martinez |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205191988 PECOS PAC ID: 8527206648 Enrollment ID: I20180818000026 |
| Provider Name | Olivia M Winters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568844652 PECOS PAC ID: 6608180914 Enrollment ID: I20190814000580 |
| Provider Name | Erica Shaw |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689179061 PECOS PAC ID: 8820405251 Enrollment ID: I20210331000231 |
| Provider Name | Gerthy Cipus Pierre |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083126353 PECOS PAC ID: 8224391495 Enrollment ID: I20220517001200 |
Acorn Counseling & Mediation, Ltd Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 101 Mccausland St, Carlinville, IL 62626 Phone: 217-930-2106 Fax: 217-716-2265 | |
Margaret Perry, Lcsw Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 40 Carlinville Plz, Carlinville, IL 62626 Phone: 217-705-4550 Fax: 217-705-4213 | |
Locust Street Resource Center Cila #1 Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 124 W Buchanan St, Carlinville, IL 62626 Phone: 217-854-3166 Fax: 217-854-9729 | |
Margaret Perry Lcsw Pc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 311 W Main St, Carlinville, IL 62626 Phone: 217-705-4550 Fax: 217-705-4213 |