Provider Demographics
NPI:1528376985
Name:COUNTERMEASURES, INC.
Entity Type:Organization
Organization Name:COUNTERMEASURES, INC.
Other - Org Name:DUI COUNTERMEASURES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MATURY
Authorized Official - Suffix:
Authorized Official - Credentials:MHS, CADC
Authorized Official - Phone:309-827-0818
Mailing Address - Street 1:110 N. CENTER
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5002
Mailing Address - Country:US
Mailing Address - Phone:309-827-0818
Mailing Address - Fax:309-828-3764
Practice Address - Street 1:110 N. CENTER
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5002
Practice Address - Country:US
Practice Address - Phone:309-827-0818
Practice Address - Fax:309-828-3764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-1028-0004-A101YA0400X
ILA-1028-0005-A101YA0400X
ILA-1028-0001-A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty