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
124-126 S. CHICAGO STREET, LINCOLN, IL 62656
(217) 732-6865
(217) 732-7845
Mailing address
3248 VANDEVER AVE, PEKIN, IL 61554-6257
(309) 347-5522
(309) 347-4264
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
949000
MEDICARE
IL
Enumeration date
02/16/2010
Last updated
07/12/2018
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