Provider Demographics
NPI:1093036048
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:MS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:A
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:217-824-9675
Mailing Address - Fax:217-824-3070
Practice Address - Street 1:707 MCADAM DR
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-0438
Practice Address - Country:US
Practice Address - Phone:217-824-9675
Practice Address - Fax:217-824-3070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services