TAZWOOD MENTAL HEALTH CENTER, INC. (NPI# 1760958797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760958797 |
| Entity Type | Organization |
| Organization Name | TAZWOOD MENTAL HEALTH CENTER, INC. |
| Practice Address |
124 S Chicago St Lincoln IL 62656-2719 |
| Mailing Address |
3248 Vandever Ave Pekin IL 61554-6257 |
| Practice Telephone | 2177326865 |
| Mailing Telephone | 3094775552 |
| Mailing Fax Number | 3093474264 |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |
| Authorized Official Name | DAVID MINGUS (CEO) |
| Authorized Official Telephone | 3093475579 |
| Authorized Official Credential | LCPC, CRADC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Tazwood Center for Wellness | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629444070 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 210 W. Walnut Street, Canton, IL 61520-2444 | 2015-08-19 |
| 1134464316 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 101 S. Major Street, Eureka, IL 61530 | 2012-11-29 |
| 1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
| 1013186683 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1421 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1568631133 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment Facility, Mental Illness | 1425 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1356466007 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-20 |
| 1538540190 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 601 Taylor St, East Peoria, IL 61611 | 2015-06-09 |
| 1629247366 | Tazwood Mental Health Center, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1423 Valle Vista Blvd, Pekin, IL 61554 | 2008-02-27 |
| 1851417091 | Tazwood Mental Health Center, Inc. | Counselor | 3248 Vandever Ave, Pekin, IL 61554-6257 | 2007-03-21 |
| 1760508907 | Tazwood Mental Health Center, Inc. | Counselor | 111 W. Washington Street, Suite 230, East Peoria, IL 61611 | 2007-03-21 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | TAZWOOD MENTAL HEALTH CENTER, INC. | 3248 Vandever Ave, Pekin, IL 61554-6257 |
| Street Address |
124 S CHICAGO ST |
| City | LINCOLN |
| State | IL |
| Zip Code | 62656-2719 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437678943 | Carissa Jo O'donoghue | Speech-Language Pathologist | 1000 Railer Way, Lincoln, IL 62656 | 2017-09-15 |
| 1083972012 | Cynthia Dorchinecz | Speech-Language Pathologist | 200 Fifth Street, Lincoln, IL 62656 | 2012-04-27 |
| 1104100114 | Jan E Fehrenbacher | Pharmacist | 603 Woodlawn, Lincoln, IL 62656 | 2011-10-10 |
| 1053633263 | Tazwood Mental Health Center, Inc. | Community/Behavioral Health | 124-126 S. Chicago Street, Lincoln, IL 62656 | 2010-02-16 |
| 1649428756 | Diane E Ulrich | Dentist | 400 N. Chicago St, Lincoln, IL 62656 | 2008-09-03 |
| 1922202944 | Robert C Miller | Dentist | 217 S Kickapoo St, Lincoln, IL 62656 | 2007-06-13 |
| 1720290638 | Lifetime Dental Care of Illinois, PC | Dentist | 411 Keokuk Street, Lincoln, IL 62656 | 2007-05-04 |
| 1982734539 | Wal-mart Stores, Inc. Dba Wal-mart | Technician/Technologist | 825 Malerich Dr., Lincoln, IL 62656 | 2007-03-06 |
| 1861571663 | David R Hepler II | Chiropractor | 2000 Pulaski Street, Lincoln, IL 62656 | 2006-11-03 |
| 1477561793 | Raymond Todd Nobbe | Optometrist | 1400 Woodlawn Road, Lincoln, IL 62656 | 2006-08-03 |
| Find all providers in zip 62656 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780168344 | David L Sullivan Ladc Plmhp | Clinic/Center | 1620 S 70th St Ste 101, Lincoln, NE 68506-1563 | 2018-09-19 |
| 1073004586 | Navigate LLC | Clinic/Center | 4535 Normal Blvd Ste 142, Lincoln, NE 68506 | 2018-05-21 |
| 1124546460 | Bonnie Brown | Clinic/Center | 2130 S 17th St #100, Lincoln, NE 68502-6850 | 2017-09-07 |
| 1225379936 | Brainwavebalance of Lincoln | Clinic/Center | 5930 S 58th St Ste O, Lincoln, NE 68516-3653 | 2013-03-05 |
| 1306170295 | Department of Veterans Affairs | Clinic/Center | 99 River Rd, Lincoln, ME 04457-4012 | 2009-09-24 |
| 1457396863 | Family Psychiatric Associates of Lincoln P.C. | Clinic/Center | 5539 S 27th St, Suite 206, Lincoln, NE 68512-1611 | 2006-06-19 |
| 1831707868 | Alexandria Reznicek Mental Health Services LLC | Clinic/Center | 5539 S 27th St Ste 101, Lincoln, NE 68512-1600 | 2020-07-15 |
| 1528676749 | Trisha Lott Behavioral Health, LLC | Clinic/Center | 1203 High St, Lincoln, NE 68502-4560 | 2020-07-14 |
| 1811517808 | Morgan M Reichmuth Counseling LLC | Clinic/Center | 8101 O St Ste 300, Lincoln, NE 68510-2647 | 2020-04-20 |
| 1386279347 | Grit Counseling LLC | Clinic/Center | 3701 Union Dr Ste 100, Lincoln, NE 68516-6629 | 2020-03-10 |
| Find all providers in LINCOLN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.