MOULTRIE COUNTY MENTAL HEALTH CENTER (NPI# 1811025240) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811025240 |
| Entity Type | Organization |
| Organization Name | MOULTRIE COUNTY MENTAL HEALTH CENTER |
| Practice Address |
12 W Harrison St Sullivan IL 61951-1907 |
| Practice Telephone | 2177284358 |
| Practice Fax Number | 2177282270 |
| Mailing Telephone | 2177284358 |
| Mailing Fax Number | 2177282270 |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2016-07-25 |
| Authorized Official Name | MR. DAVID L. COLE (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2177284358 |
| Authorized Official Credential | MSW, LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
A-0043-0002-A | IL | Behavioral Health & Social Service Providers |
| N | 101YM0800X |
Counselor Specialization: Mental Health |
04105 | IL | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
180.005810 | IL | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
178.004724 | IL | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
180.003537 | IL | Behavioral Health & Social Service Providers |
| N | 1041C0700X |
Social Worker Specialization: Clinical |
149.011051 | IL | Behavioral Health & Social Service Providers |
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
36052881 | IL | Ambulatory Health Care Facilities |
| Y | 251S00000X | Community/Behavioral Health | 04105 | IL | Agencies |
| Street Address |
12 W HARRISON ST |
| City | SULLIVAN |
| State | IL |
| Zip Code | 61951-1907 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912522384 | Emilee Anne Kruchten | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2020-06-11 |
| 1245859693 | Ashlynn Kaye Pinney | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2020-04-15 |
| 1275152670 | Macie Anna Miller | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2020-04-15 |
| 1407403165 | Nina Harris | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2019-08-19 |
| 1720648579 | Elizabeth Joy Vanneste | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2019-06-14 |
| 1346808227 | Darla Schibur | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2019-06-05 |
| 1518421585 | Paige Victoria Darnell | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2019-01-24 |
| 1952865925 | Danielle Beamon | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2019-01-24 |
| 1518444389 | Victoria Youngs | Counselor | 12 W Harrison St, Sullivan, IL 61951-1907 | 2018-07-25 |
| 1457838179 | Angela Schmohe | Social Worker | 12 W Harrison St, Sullivan, IL 61951-1907 | 2018-07-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497104558 | Laura Ellis | Speech-Language Pathologist | 1 Masonic Way, Sullivan, IL 61951 | 2016-06-09 |
| 1134561665 | Murray Chiropractic and Acupuncture, LLC | Chiropractor | 221 N Anderson St, Sullivan, IL 61951-1001 | 2013-07-25 |
| 1427450220 | Harley Chiropractic, LLC | Chiropractor | 221 N Anderson St, Sullivan, IL 61951-1001 | 2014-09-23 |
| 1104822568 | Patricia E Carr | Nurse Practitioner | 1220 W Jackson St, Sullivan, IL 61951-1032 | 2005-06-21 |
| 1396789590 | Healthcom, Inc | Emergency Response System Companies | 1600 W Jackson St, Sullivan, IL 61951-1066 | 2006-06-16 |
| 1598275646 | Janice Althoff | Speech-Language Pathologist | 910 N Graham St, Sullivan, IL 61951-1114 | 2017-10-03 |
| 1134639289 | Anne Margaret Osthoff | Speech-Language Pathologist | 910 N Graham St, Sullivan, IL 61951-1114 | 2017-10-03 |
| 1891857447 | William Earl Alwerdt | Dentist | 110 N Hamilton St, Sullivan, IL 61951-1405 | 2006-12-13 |
| 1548511819 | Cindi L Reed | Pharmacist | 17 N Hamilton St, Sullivan, IL 61951-1452 | 2012-09-27 |
| 1306466263 | Reed Pharmacies, LLC | Family Medicine | 17 N Hamilton St, Sullivan, IL 61951-1452 | 2020-04-21 |
| Find all providers in zip 61951 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144820648 | Community Wellness Group | Community/Behavioral Health | 635 Argyle Ave, Flossmoor, IL 60422-1201 | 2020-10-26 |
| 1437758711 | Gina Baldacci, Lcsw, LLC | Community/Behavioral Health | 231 Longridge Dr, Bloomingdale, IL 60108 | 2020-10-19 |
| 1790383610 | Joni Lamb Therapy, LLC | Community/Behavioral Health | 1555 Sherman Ave # 308, Evanston, IL 60201-4421 | 2020-10-13 |
| 1811594906 | Everyday Empowered Clinical Services, Ltd. | Community/Behavioral Health | 5117 Main St, Suite #7, Downers Grove, IL 60515 | 2020-10-02 |
| 1942817150 | Pacem Wellness, LLC | Community/Behavioral Health | 8 Eagle Ctr Ste 12, O Fallon, IL 62269-1947 | 2020-09-30 |
| 1831703271 | Boules Clinical Psychology Group | Community/Behavioral Health | 200 S Frontage Rd Ste 324, Burr Ridge, IL 60527-6953 | 2020-09-02 |
| 1336753896 | Counseling Kennedy Shenberg | Community/Behavioral Health | 5752 N Campbell Ave Apt 1, Chicago, IL 60659-5080 | 2020-09-02 |
| 1265045371 | Brightside Recovery | Community/Behavioral Health | 1667 Belvidere Rd, Belvidere, IL 61008-9306 | 2020-08-28 |
| 1902419021 | Brightside Recovery | Community/Behavioral Health | 8041 186th St Ste B, Tinley Park, IL 60487-9344 | 2020-08-28 |
| 1700498573 | Bobby E. Wright Comprehensive Behavioral Health Center, Inc. | Community/Behavioral Health | 5816 W Division St Fl 1, Chicago, IL 60651-1003 | 2020-08-21 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MOULTRIE COUNTY MENTAL HEALTH CENTER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.