Provider Demographics
NPI:1710518741
Name:WEBSTER CANTRELL YOUTH ADVOCACY
Entity Type:Organization
Organization Name:WEBSTER CANTRELL YOUTH ADVOCACY
Other - Org Name:WCYA SATELLITE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS,ED, LCPC, CADC
Authorized Official - Phone:217-423-6961
Mailing Address - Street 1:1942 E CANTRELL ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3214
Mailing Address - Country:US
Mailing Address - Phone:217-423-6961
Mailing Address - Fax:217-421-6889
Practice Address - Street 1:202 E ELDORADO ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62523-1039
Practice Address - Country:US
Practice Address - Phone:217-422-7864
Practice Address - Fax:217-422-1324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEBSTER CANTRELL YOUTH ADVOCACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-29
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty