Provider Demographics
NPI:1891856795
Name:ASSOCIATES IN MENTAL HEALTH, SC
Entity type:Organization
Organization Name:ASSOCIATES IN MENTAL HEALTH, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:EMIL
Authorized Official - Last Name:COLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-637-4266
Mailing Address - Street 1:900 MAIN ST
Mailing Address - Street 2:SUITE 580
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-1005
Mailing Address - Country:US
Mailing Address - Phone:309-637-4266
Mailing Address - Fax:309-637-9836
Practice Address - Street 1:900 MAIN ST
Practice Address - Street 2:SUITE 580
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-1005
Practice Address - Country:US
Practice Address - Phone:309-637-4266
Practice Address - Fax:309-637-9836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL319975OtherVALUE OPTIONS
IL07200526OtherBLUE CROSS BLUE SHIELD
ILCN0459OtherRAILROAD MEDICARE
IL319975OtherVALUE OPTIONS