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
1423 VALLE VISTA BLVD, PEKIN, IL 61554
(309) 347-5579
(309) 347-4264
Mailing address
3248 VANDEVER AVE, PEKIN, IL 61554-6257
(309) 347-5522
(309) 347-4264
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/27/2008
Last updated
07/12/2018
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