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Organization
TAZWOOD MENTAL HEALTH CENTER, INC.
Active
Organization
TAZWOOD MENTAL HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVE WALTER MINGUS LCPC (CEO)
(309) 347-5579
Entity
Organization
Contact information
Practice address
3248 VANDEVER AVE, PEKIN, IL 61554
(309) 347-5522
(309) 347-4264
Mailing address
3248 VANDEVER AVE, PEKIN, IL 61554
(309) 347-5522
(309) 347-4264
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
163W00000X
Registered Nurse
—
—
171M00000X
Case Manager/Care Coordinator
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
04132
IL
Other
Enumeration date
05/01/2006
Last updated
01/16/2017
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