Provider Demographics
NPI:1255500377
Name:COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE BEHAVIORAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MBA, CADC
Authorized Official - Phone:618-482-7330
Mailing Address - Street 1:505 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST SAINT LOUIS
Mailing Address - State:IL
Mailing Address - Zip Code:62201-2919
Mailing Address - Country:US
Mailing Address - Phone:618-482-7330
Mailing Address - Fax:
Practice Address - Street 1:505 S 8TH ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62201-2919
Practice Address - Country:US
Practice Address - Phone:618-482-7330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE MENTAL HEALTH CENTER OF ST. CLAIR COUNTY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-22
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04037Medicaid
IL=========010Medicaid
IL=========012Medicaid
IL=========014Medicaid
IL=========013Medicaid
IL=========015Medicaid
IL=========001Medicaid
IL=========004Medicaid