Organization · NPI-2

Youth Service Bureau Of Illinois Valley

Clinic/Center, Mental Health (Including Community Mental Health Center) · Ottawa, IL

NPI number1164757266
StatusActive
Last updated in NPPESSep 20, 2022

Details

NPI
1164757266
Entity type
Organization (NPI-2)
Legal business name
Youth Service Bureau Of Illinois Valley
Organization subpart
No
Enumeration date
Oct 7, 2009
Certification date
Sep 20, 2022
Last updated
Sep 20, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––Yes
251S00000X Community/Behavioral Health149.013808IL
251S00000X Community/Behavioral Health1041C0700XIL

Practice location

424 W Madison St
Ottawa, IL 61350-2833

Phone 815-433-3953 · Fax 815-433-3980

Mailing address

424 W Madison St
Ottawa, IL 61350-2833

Phone 815-433-3953 · Fax 815-433-3980

Authorized official

Lisa Kay Gustafson
Treatment Coordinator
8154313022

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