Organization
MOULTRIE COUNTY MENTAL HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID L. COLE MSW, LCSW (EXECUTIVE DIRECTOR)
(217) 728-4358
Entity
Organization
Contact information
Practice address
12 W HARRISON ST, SULLIVAN, IL 61951-1907
(217) 728-4358
(217) 728-2270
Mailing address
12 W HARRISON ST, SULLIVAN, IL 61951-1907
(217) 728-4358
(217) 728-2270
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
A-0043-0002-A
IL
101YM0800X
Mental Health Counselor
04105
IL
101YP2500X
Professional Counselor
178.004724
IL
101YP2500X
Professional Counselor
180.003537
IL
101YP2500X
Professional Counselor
180.005810
IL
1041C0700X
Clinical Social Worker
149.011051
IL
251S00000X
Community/Behavioral Health Agency
Primary
04105
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
36052881
IL
Other
Enumeration date
02/28/2007
Last updated
07/25/2016
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