YOUTH SERVICE BUREAU OF ILLINOIS VALLEY NPI 1164757266

NPI Information

NPI: 1164757266
Provider Name: YOUTH SERVICE BUREAU OF ILLINOIS VALLEY
Classification: Clinic/Center - 261QM0801X
Entity Type: Organization

Specialization: Mental Health (Including Community Mental Health Center)

Address:
424 W MADISON ST
OTTAWA, IL
ZIP 61350
Phone: (815) 433-3953
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YOUTH SERVICE BUREAU OF ILLINOIS VALLEY is a mental health (including community mental health center) clinic center in Ottawa, IL. YOUTH SERVICE BUREAU OF ILLINOIS VALLEY NPI is 1164757266. The provider is registered as an organization entity type.

The provider's business location address is:

424 W MADISON ST
OTTAWA, IL
ZIP 61350-833
Phone: (815) 433-3953
Fax: (815) 433-3980

The provider's authorized official is Lisa Kay Gustafson .
The authorized official title is Treatment Coordinator and has the following contact phone number (815) 431-3022.

The enumeration date for this NPI number is 10/7/2009 and was last updated on 9/20/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	251S00000X	Community/Behavioral Health		149.013808	ILLINOIS	No
2	251S00000X	Community/Behavioral Health		1041C0700X	ILLINOIS	No
3	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	149.013808	OTHER	ILLINOIS	LICENSED CLINICAL SOCIAL WORKER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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