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601 Taylor St East Peoria IL 61611 | |
| (309) 347-5522 | |
| (309) 347-4264 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 601 Taylor St, East Peoria, Illinois |
| Authorized Official Name and Position | David W. Mingus (CEO) |
| Authorized Official Contact | 3094775525 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
3248 Vandever Ave Pekin IL 61554-6257 Ph: (309) 347-5522 | 601 Taylor St East Peoria IL 61611 Ph: (309) 347-5522 |
| NPI Number | 1538540190 |
|---|---|
| Provider Enumeration Date | 06/09/2015 |
| Last Update Date | 07/12/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538540190 | NPI | - | NPPES |
| 949000 | Medicaid | IL |
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