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Organization
YOUTH SERVICE BUREAU OF ILLINOIS VALLEY
Active
Organization
YOUTH SERVICE BUREAU OF ILLINOIS VALLEY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LISA KAY GUSTAFSON LCPC (TREATMENT COORDINATOR)
(815) 433-3953
Entity
Organization
Contact information
Practice address
1700 N FARNSWORTH AVE STE 18, AURORA, IL 60505-1186
(630) 820-6303
(630) 820-6306
Mailing address
424 W MADISON ST, OTTAWA, IL 61350-2833
(815) 433-3953
(815) 433-3980
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
1041C0700X
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/29/2012
Last updated
09/20/2022
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