| Macomb Mental Wellness Llc | |
|
210 S Randolph St Macomb IL 61455-3828 | |
| (217) 779-6063 | |
| Not Available |
| Full Name | Macomb Mental Wellness Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 210 S Randolph St, Macomb, Illinois |
| Authorized Official Name and Position | Joseph William Proctor (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 2177796063 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Macomb Mental Wellness Llc 6482 Lakeshore View Dr Rushville IL 62681-4707 Ph: (217) 779-6063 | Macomb Mental Wellness Llc 210 S Randolph St Macomb IL 61455-3828 Ph: (217) 779-6063 |
| NPI Number | 1548863194 |
|---|---|
| Provider Enumeration Date | 11/17/2020 |
| Last Update Date | 11/17/2020 |
| Certification Date | 11/17/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548863194 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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