Provider Demographics
NPI:1457505125
Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Entity Type:Organization
Organization Name:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Other - Org Name:MEMORIAL BEHAVIORAL HEALTH - SPRINGFIELD CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-588-2626
Mailing Address - Street 1:710 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6324
Mailing Address - Country:US
Mailing Address - Phone:217-525-1064
Mailing Address - Fax:217-525-1651
Practice Address - Street 1:710 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6324
Practice Address - Country:US
Practice Address - Phone:217-525-1064
Practice Address - Fax:217-525-1651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MENTAL HEALTH CENTERS OF CENTRAL ILLINOIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-07
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health