Provider Demographics
NPI:1023675634
Name:COUNTY OF MCLEAN
Entity type:Organization
Organization Name:COUNTY OF MCLEAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIORAL HEALTH COORD
Authorized Official - Prefix:
Authorized Official - First Name:MARITA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-888-5700
Mailing Address - Street 1:200 W FRONT ST STE 304
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-5067
Mailing Address - Country:US
Mailing Address - Phone:309-888-5700
Mailing Address - Fax:309-862-8501
Practice Address - Street 1:200 W FRONT ST STE 304
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-5067
Practice Address - Country:US
Practice Address - Phone:309-888-5700
Practice Address - Fax:309-862-8501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)