Organization
CENTER FOR PSYCHIATRIC HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. WENDI D GRAHAM (EXECUTIVE ASSISTANT)
(217) 479-5663
Entity
Organization
Contact information
Practice address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 243-2206
Mailing address
1600 W WALNUT ST, JACKSONVILLE, IL 62650-1136
(217) 245-9541
(217) 243-2206
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6932018
BCBS
IL
Enumeration date
02/11/2008
Last updated
03/22/2018
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