Provider Demographics
NPI:1245233493
Name:MCLEAN COUNTY CENTER FOR HUMAN SERVICES, INC
Entity Type:Organization
Organization Name:MCLEAN COUNTY CENTER FOR HUMAN SERVICES, INC
Other - Org Name:MCLEAN COUNTY CENTER FOR H S
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:309-827-5351
Mailing Address - Street 1:108 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3918
Mailing Address - Country:US
Mailing Address - Phone:309-827-5351
Mailing Address - Fax:309-829-6808
Practice Address - Street 1:108 W MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3918
Practice Address - Country:US
Practice Address - Phone:309-827-5351
Practice Address - Fax:309-829-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========6170105Medicaid
IL=========001Medicaid
IL=========6170101Medicaid
IL=========6170105Medicaid