Provider Demographics
NPI:1639490568
Name:CHRISTIAN COUNTY MENTAL HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:CHRISTIAN COUNTY MENTAL HEALTH ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECORDS CLERK
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-824-4905
Mailing Address - Street 1:PO BOX 438
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-0438
Mailing Address - Country:US
Mailing Address - Phone:217-824-4905
Mailing Address - Fax:217-824-3570
Practice Address - Street 1:500 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1303
Practice Address - Country:US
Practice Address - Phone:217-824-4905
Practice Address - Fax:217-824-3570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN COUNTY MENTAL HEALTH ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-15
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251S00000XAgenciesCommunity/Behavioral Health