Provider Demographics
NPI:1306093075
Name:ARROWLEAF
Entity type:Organization
Organization Name:ARROWLEAF
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:COWSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-652-2046
Mailing Address - Street 1:125 NORTH MARKET STREET
Mailing Address - Street 2:PO BOX 759
Mailing Address - City:GOLCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:62938
Mailing Address - Country:US
Mailing Address - Phone:618-683-2461
Mailing Address - Fax:618-683-2066
Practice Address - Street 1:125 NORTH MARKET STREET
Practice Address - Street 2:
Practice Address - City:GOLCONDA
Practice Address - State:IL
Practice Address - Zip Code:62938
Practice Address - Country:US
Practice Address - Phone:618-683-2461
Practice Address - Fax:618-683-2066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X, 101YM0800X, 104100000X, 106H00000X
IL04055251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========005Medicaid