Organization
MACOMB MENTAL WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH WILLIAM PROCTOR PSY.D (CLINICAL PSYCHOLOGIST)
(217) 779-6063
Entity
Organization
Contact information
Practice address
210 S RANDOLPH ST, MACOMB, IL 61455-3828
(217) 779-6063
Mailing address
6482 LAKESHORE VIEW DR, RUSHVILLE, IL 62681-4707
(217) 779-6063
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
11/17/2020
Last updated
11/17/2020
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