Provider Demographics
NPI:1336979137
Name:PROJECT OZ
Entity type:Organization
Organization Name:PROJECT OZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF YOUTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CHERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-827-0377
Mailing Address - Street 1:1105 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-4853
Mailing Address - Country:US
Mailing Address - Phone:309-827-0377
Mailing Address - Fax:309-829-8877
Practice Address - Street 1:1105 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-4853
Practice Address - Country:US
Practice Address - Phone:309-827-0377
Practice Address - Fax:309-829-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health