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4805 Broadway St Ste C Mount Vernon IL 62864-6702 | |
| (618) 228-1133 | |
| (773) 692-2323 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4805 Broadway St Ste C, Mount Vernon, Illinois |
| Authorized Official Name and Position | Heather Christine Kelly (ASST. DIRECTOR OF BEHAVIORAL HEALTH) |
| Authorized Official Contact | 2172735398 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
333 S Wabash Ave Ste 2750 Chicago IL 60604-4264 Ph: (847) 245-6598 | 4805 Broadway St Ste C Mount Vernon IL 62864-6702 Ph: (618) 228-1133 |
| NPI Number | 1194443267 |
|---|---|
| Provider Enumeration Date | 08/16/2022 |
| Last Update Date | 06/10/2024 |
| Certification Date | 06/10/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194443267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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