| Locust Street Resource Center | |
|
1630 S State St Springfield IL 62704-3682 | |
| (217) 854-3166 | |
| (217) 854-3778 |
| Full Name | Locust Street Resource Center |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1630 S State St, Springfield, Illinois |
| Authorized Official Name and Position | Sally Maguire (CREDENTIALING CLERK) |
| Authorized Official Contact | 2178543166 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Locust Street Resource Center 320 S Locust St Carlinville IL 62626-1648 Ph: (217) 854-3166 | Locust Street Resource Center 1630 S State St Springfield IL 62704-3682 Ph: (217) 854-3166 |
| NPI Number | 1023896834 |
|---|---|
| Provider Enumeration Date | 09/21/2023 |
| Last Update Date | 09/21/2023 |
| Certification Date | 09/21/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023896834 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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