NPIMap

Organization Active NPI

Youth Service Bureau of Illinois Valley

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Ottawa, IL
National Provider Identifier
1164757266
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
YOUTH SERVICE BUREAU OF ILLINOIS VALLEY
Practice address
424 W Madison St
Ottawa, IL 61350-2833
Phone
(815) 433-3953
Fax
(815) 433-3980
NPI assigned
Oct 7, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Lisa Kay Gustafson, M.S.
Title
Treatment Coordinator
Phone
(815) 431-3022

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 149.013808 IL
Community/Behavioral Health Agency 251S00000X 1041C0700X IL
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

424 W Madison St
Ottawa, IL 61350-2833

Mailing address

424 W Madison St
Ottawa, IL 61350-2833
Phone (815) 433-3953

Other identifiers 1

IdentifierTypeStateIssuer
149.013808OtherILLICENSED CLINICAL SOCIAL WORKER

National Provider Directory

National Provider Directory
Tax ID family
Youth Service Bureau of Illinois Valley8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1164757266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 W MADISON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502833",
            "telephone_number": "815-433-3953",
            "fax_number": "815-433-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 W MADISON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502833",
            "telephone_number": "815-433-3953",
            "fax_number": "815-433-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUTH SERVICE BUREAU OF ILLINOIS VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-07",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "GUSTAFSON",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "TREATMENT COORDINATOR",
        "authorized_official_telephone_number": "815-431-3022",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "149.013808",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "1041C0700X",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED CLINICAL SOCIAL WORKER",
            "identifier": "149.013808",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.