| Locust Street Resource Center Cila #2 | |
|
202 E 3rd North St Mount Olive IL 62069-1320 | |
| (217) 854-3166 | |
| (217) 854-9729 |
| Full Name | Locust Street Resource Center Cila #2 |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 202 E 3rd North St, Mount Olive, Illinois |
| Authorized Official Name and Position | Tracy Haynes (MANAGER) |
| Authorized Official Contact | 2178543166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Locust Street Resource Center Cila #2 320 S Locust St Carlinville IL 62626-1648 Ph: (217) 854-3166 | Locust Street Resource Center Cila #2 202 E 3rd North St Mount Olive IL 62069-1320 Ph: (217) 854-3166 |
| NPI Number | 1821440868 |
|---|---|
| Provider Enumeration Date | 07/01/2016 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821440868 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Illinois) | Primary |