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
308 W STATE ST, ROCKFORD, IL 61101-1117
(815) 316-1977
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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