Provider Demographics
NPI: | 1508974197 |
---|---|
Name: | PIATT COUNTY MENTAL HEALTH CENTER |
Entity Type: | Organization |
Organization Name: | PIATT COUNTY MENTAL HEALTH CENTER |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | SUSAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LOCHBAUM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 217-762-5371 |
Mailing Address - Street 1: | 1921 N MARKET ST |
Mailing Address - Street 2: | |
Mailing Address - City: | MONTICELLO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 61856-8144 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 217-762-5371 |
Mailing Address - Fax: | 217-762-4066 |
Practice Address - Street 1: | 1921 N MARKET ST |
Practice Address - Street 2: | |
Practice Address - City: | MONTICELLO |
Practice Address - State: | IL |
Practice Address - Zip Code: | 61856-8144 |
Practice Address - Country: | US |
Practice Address - Phone: | 217-762-5371 |
Practice Address - Fax: | 217-762-4066 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-25 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 101Y00000X, 101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 106H00000X, 251B00000X, 251C00000X, 251J00000X, 261QM0850X, 261QM0855X, 385H00000X, 385HR2060X | |
IL | A0277001A | 101YA0400X |
IL | 3709251539 | 261QM0801X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
Not Answered | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
Not Answered | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
Not Answered | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
Not Answered | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
Not Answered | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
Not Answered | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
Not Answered | 251B00000X | Agencies | Case Management | ||
Not Answered | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
Not Answered | 251J00000X | Agencies | Nursing Care | ||
Not Answered | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
Not Answered | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
Not Answered | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
Not Answered | 385H00000X | Respite Care Facility | Respite Care | ||
Not Answered | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | =========002 | Medicaid | |
IL | =========001 | Medicaid | |
IL | 211879 | Medicare ID - Type Unspecified |