Supported Residential

Primary specialty

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

Legal business name

SUPPORTED RESIDENTIAL

Practice address

710 W Mulberry St
Bloomington, IL 61701-2868

Phone

(309) 827-0067

NPI assigned

Mar 22, 2023

Organization subpart

Yes

Parent organization

MCLEAN CO CTR FOR HUMAN SERVICESAs reported in NPPES

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

Authorized official

Name

June Peterson -Middlebrooks

Title

Accounts Receivable

Phone

(309) 827-5351

Specialties & licenses 1

Addresses

Other names 1

• MCLEAN COUNTY CENTER FOR HUMAN SERVICES Other name

Part of

Supported Residential

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

{
    "created_epoch": "1679443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679443200000",
    "number": "1578266342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 W MULBERRY ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617012868",
            "telephone_number": "309-827-5351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 W MULBERRY ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617012868",
            "telephone_number": "309-827-0067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORTED RESIDENTIAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCLEAN CO CTR FOR HUMAN SERVICES",
        "enumeration_date": "2023-03-22",
        "last_updated": "2023-03-22",
        "certification_date": "2023-03-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON -MIDDLEBROOKS",
        "authorized_official_first_name": "JUNE",
        "authorized_official_title_or_position": "ACCOUNTS RECEIVABLE",
        "authorized_official_telephone_number": "309-827-5351"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCLEAN COUNTY CENTER FOR HUMAN SERVICES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jennifer Renee Sullivan
• Jessica M Sullivan, CNP
• Ken James Summers, MS, LMFT
• Summit Family Medical Center
• Superior Anesthesia Solutions, LLC
• Surgical Associates of Bloomington, Ill,LTD
• Adriann Sutton
• Ashley Sutton, BS, CADC
• Trevor Alan Suyak, APRN, FNP
• Kathryn A Swain-Abraham, APN

• Mental Health Clinic/Center (Including Community Mental Health Center) in Bloomington, IL
• Providers in Bloomington, 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 Mar 22, 2023; 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.