Organization
JEFFERSON COUNTY COMPREHENSIVE
Active
Other names
Substance Abuse Outpatient
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL P BOEHMER MA, LCPC, QMHP (EXECUTIVE DIRECTOR)
(618) 242-1994
Entity
Organization
Contact information
Practice address
16338 N IL HWY 37, MT VERNON, IL 62864
(618) 242-1994
(618) 242-6392
Mailing address
PO BOX 428, MOUNT VERNON, IL 62864-0054
(618) 242-1994
(618) 242-6392
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
002250003
IL
324500000X
Substance Abuse Rehabilitation Facility
Primary
002250003
IL
Other
Enumeration date
05/05/2009
Last updated
08/17/2018
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