Provider Demographics
NPI:1295132728
Name:P.A.T.S. PREVENTION AND TREATMENT SERVICES
Entity type:Organization
Organization Name:P.A.T.S. PREVENTION AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:217-954-1128
Mailing Address - Street 1:300 S BROADWAY AVE
Mailing Address - Street 2:STE 110 A
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-3449
Mailing Address - Country:US
Mailing Address - Phone:217-954-1128
Mailing Address - Fax:217-954-1514
Practice Address - Street 1:300 S BROADWAY AVE
Practice Address - Street 2:STE 110 A
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-3449
Practice Address - Country:US
Practice Address - Phone:217-954-1128
Practice Address - Fax:217-954-1514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490093551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty