| Tazwood Mental Health Center, Inc. | |
|
3248 Vandever Ave Pekin IL 61554 | |
| (309) 347-5522 | |
| (309) 347-4264 |
| Full Name | Tazwood Mental Health Center, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3248 Vandever Ave, Pekin, Illinois |
| Authorized Official Name and Position | Dave Walter Mingus (CEO) |
| Authorized Official Contact | 3093475579 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tazwood Mental Health Center, Inc. 3248 Vandever Ave Pekin IL 61554 Ph: (309) 347-5522 | Tazwood Mental Health Center, Inc. 3248 Vandever Ave Pekin IL 61554 Ph: (309) 347-5522 |
| NPI Number | 1083671127 |
|---|---|
| Provider Enumeration Date | 05/01/2006 |
| Last Update Date | 01/16/2017 |
| Medicare PECOS PAC ID | 1850291741 |
|---|---|
| Medicare Enrollment ID | O20040108000963 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083671127 | NPI | - | NPPES |
| Provider Name | Pratap K Attaluri |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689639213 PECOS PAC ID: 6204960073 Enrollment ID: I20100816000438 |
| Provider Name | Robert Allan Lizer |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1184624280 PECOS PAC ID: 5496870651 Enrollment ID: I20100913000462 |
| Provider Name | James P Ausfahl |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518058619 PECOS PAC ID: 6406024983 Enrollment ID: I20110728000156 |
| Provider Name | Edward G Betzelberger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1598190548 PECOS PAC ID: 5496988628 Enrollment ID: I20140423002377 |
| Provider Name | John Voris |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790125193 PECOS PAC ID: 7315268109 Enrollment ID: I20161025001149 |
| Provider Name | Jonathan W Mooney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427603935 PECOS PAC ID: 2769812098 Enrollment ID: I20200428001487 |
| Provider Name | Joseph M Babione |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417575853 PECOS PAC ID: 4082034392 Enrollment ID: I20201026000589 |
| Provider Name | Zaki Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285172239 PECOS PAC ID: 5698175271 Enrollment ID: I20210618001148 |
| Provider Name | Kira M Furkin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164196648 PECOS PAC ID: 1557751955 Enrollment ID: I20211129000719 |
| Provider Name | Jalisa N Smith-jordan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659015451 PECOS PAC ID: 2466830740 Enrollment ID: I20220526002342 |
| Provider Name | Susan Sarita Walsh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821877010 PECOS PAC ID: 8628426152 Enrollment ID: I20231122001077 |
| Provider Name | Robert John Mooney |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013975648 PECOS PAC ID: 7618312042 Enrollment ID: I20240226001704 |
Tazwood Mental Health Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3248 Vandever Ave, Pekin, IL 61554 Phone: 309-347-5579 Fax: 309-347-5579 | |
Tazwood Mental Health Center, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1421 Valle Vista Blvd, Pekin, IL 61554 Phone: 309-347-5579 Fax: 309-347-4264 | |
Jessie Shanks Counseling, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 514 Broadway St Unit 1351, Pekin, IL 61555 Phone: 309-322-2900 Fax: 309-322-2901 | |
Tazwood Center For Human Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 3248 Vandever Ave, Pekin, IL 61554 Phone: 309-347-5522 Fax: 309-347-4264 | |
Abc Counseling & Family Services Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 359 Margaret St, Pekin, IL 61554 Phone: 309-349-3886 Fax: 309-620-8647 | |
Revive Wellness Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 802 Bacon St, Pekin, IL 61554 Phone: 309-219-5057 |