County of Jasper
Organization Active NPI Mental Health Clinic/Center (Including Community Mental Health Center) · Newton, IL
NPI 1073782579 · NPPES record last updated Mar 3, 2022
Key facts
- NPI
- 1073782579
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
- Legal business name
- COUNTY OF JASPER
- Practice address
- 106 East Edwards
Newton, IL 62448-1736 - Phone
- (618) 783-4154
- Fax
- (618) 783-2339
- NPI assigned
- Feb 28, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- COUNTY OF JASPER
Authorized official
- Name
- Ms. Deborah K Clark, BS
- Title
- Administrator
- Phone
- (618) 783-4154
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 7
Practitioners 7
-
Holly Harris, MSW, LCSW
-
Jeanne E. Holdren, APN
-
Abbegail E Lomas, MSW, LCSW
-
Emily Marie Smith, MS, LCPC, NCC, CCTP
-
Kristen Will, MS, LCPC, NCC
-
Emily N Heuerman, BS
-
Jeannie Johnson, MS, LCPC, CADC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070601000074 | IL | Part B Supplier - Clinic/Group Practice | 6901904796 |
Receives reassigned benefits from 7 practitioners 4 other NPIs on this enrollment Practice locations: Newton, IL; Olney, IL |
National Provider Directory
- Tax ID family
- County of Jasper
- Part of
- County of Jasper
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | 04082 | IL | |
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | Yes |
Addresses
Primary practice location
106 East Edwards
Newton, IL 62448-1736
Mailing address
106 East Edwards
Newton, IL 62448-1736
Phone (618) 783-4154
Other providers in Newton, IL
- Caitlin Chapman
- Kierstin Clark
- Haylee Ann Cohorst
- Charles T Coleman
- Matthew A Cooley
- County of Jasper
- County of Jasper
- Crawford Hospital District
- Amy Deel-Hout
- Donna Dhom
All providers in Newton, IL · Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.