NPIMap

Organization Active NPI

Moultrie County Mental Health Center

  • Community/Behavioral Health Agency
  • Sullivan, IL
National Provider Identifier
1811025240
Registry record updated Jul 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
04105 Issued in IL
Legal business name
MOULTRIE COUNTY MENTAL HEALTH CENTER
Practice address
12 W Harrison St
Sullivan, IL 61951-1907
Phone
(217) 728-4358
Fax
(217) 728-2270
NPI assigned
Feb 28, 2007
Last updated
Jul 25, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2016

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

Authorized official

Name
Mr. David L. Cole, MSW, LCSWNPI 1164660775
Title
Executive Director
Phone
(217) 728-4358

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X 36052881 IL
Addiction (Substance Use Disorder) Counselor 101YA0400X A-0043-0002-A IL
Mental Health Counselor 101YM0800X 04105 IL
Professional Counselor 101YP2500X 180.005810 IL
Professional Counselor 101YP2500X 178.004724 IL
Professional Counselor 101YP2500X 180.003537 IL
Clinical Social Worker 1041C0700X 149.011051 IL
Community/Behavioral Health Agency 251S00000X 04105 IL Primary

Addresses

Primary practice location

12 W Harrison St
Sullivan, IL 61951-1907

Mailing address

12 W Harrison St
Sullivan, IL 61951-1907
Phone (217) 728-4358

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160725002454 IL Part B Supplier - Clinic/Group Practice 9739268996 Receives reassigned benefits from 4 practitioners
Practice locations: Sullivan, IL

National Provider Directory

National Provider Directory

Locations

12 W Harrison St
Sullivan, IL 61951
Phone (217) 728-4358

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469404800000",
    "number": "1811025240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 W HARRISON ST",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619511907",
            "telephone_number": "217-728-4358",
            "fax_number": "217-728-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W HARRISON ST",
            "city": "SULLIVAN",
            "state": "IL",
            "postal_code": "619511907",
            "telephone_number": "217-728-4358",
            "fax_number": "217-728-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOULTRIE COUNTY MENTAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-07-25",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "217-728-4358",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW, LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "36052881",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "A-0043-0002-A",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "04105",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.005810",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.004724",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.003537",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.011051",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IL",
            "license": "04105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sullivan, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.