| Mclean County Fuse Program | |
|
200 W Front St Ste 400e Bloomington IL 61701-5048 | |
| (309) 434-6510 | |
| (309) 888-5111 |
| Full Name | Mclean County Fuse Program |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 200 W Front St Ste 400e, Bloomington, Illinois |
| Authorized Official Name and Position | Trisha P Malott (BHCC SUPERVISOR) |
| Authorized Official Contact | 3094346510 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mclean County Fuse Program 200 W Front St, Suite 500d Attn: Trisha Malott, Bhcc Supervisor Bloomington IL 61701 Ph: (309) 434-6510 | Mclean County Fuse Program 200 W Front St Ste 400e Bloomington IL 61701-5048 Ph: (309) 434-6510 |
| NPI Number | 1023675634 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 08/31/2021 |
| Certification Date | 08/31/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023675634 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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