Provisionii Behaviorial Health LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

PROVISIONII BEHAVIORIAL HEALTH LLC

Practice address

820 SW Adams St
Peoria, IL 61602-1623

Phone

(309) 223-4171

Fax

(309) 223-4125

NPI assigned

Sep 29, 2025

Last updated

Sep 29, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brandon M Russell

Title

Founder & Ceo

Phone

(309) 223-4171

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1759104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759104000000",
    "number": "1306710850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 SW ADAMS ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021623",
            "telephone_number": "309-223-4171",
            "fax_number": "309-223-4125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 SW ADAMS ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021623",
            "telephone_number": "309-223-4171",
            "fax_number": "309-223-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISIONII BEHAVIORIAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-29",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "FOUNDER & CEO",
        "authorized_official_telephone_number": "309-223-4171"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Clinic/Center (Including Community Mental Health Center) in Peoria, IL
• Providers in Peoria, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; 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.