Provider Demographics
NPI:1124250402
Name:DUI SOLUTIONS & TREATMENT ALTERNATIVES, INC.
Entity type:Organization
Organization Name:DUI SOLUTIONS & TREATMENT ALTERNATIVES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAST
Authorized Official - Suffix:
Authorized Official - Credentials:CADC, NCAC II, CCJS
Authorized Official - Phone:309-828-1988
Mailing Address - Street 1:207 W JEFFERSON ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3960
Mailing Address - Country:US
Mailing Address - Phone:309-828-1988
Mailing Address - Fax:309-828-6540
Practice Address - Street 1:207 WEST JEFFERSON STREET
Practice Address - Street 2:SUITE 501
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701
Practice Address - Country:US
Practice Address - Phone:309-828-1988
Practice Address - Fax:309-828-6540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0020481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL104100000XOtherINSURANCE
IL106H00000XOtherINSURANCE
IL101Y00000XOtherINSURANCE