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200 W Front St Ste 304 Bloomington IL 61701-5067 | |
| (309) 888-5700 | |
| (309) 862-8501 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 200 W Front St Ste 304, Bloomington, Illinois |
| Authorized Official Name and Position | Marita Landreth (DIRECTOR OF BEHAVIORAL HEALTH COORD) |
| Authorized Official Contact | 3098885700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 W Front St Ste 304 Bloomington IL 61701-5067 Ph: (309) 888-5700 | 200 W Front St Ste 304 Bloomington IL 61701-5067 Ph: (309) 888-5700 |
| NPI Number | 1023675634 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 02/05/2025 |
| Certification Date | 02/05/2025 |
| 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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