Provisionii Behaviorial Health LLC

NPI #1306710850 in Peoria, Illinois

Provider Information

NPI Number: 1306710850
Entity Type: Organization
Organization Name: Provisionii Behaviorial Health LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Sep 29, 2025
Last Updated: Sep 29, 2025

Practice Location

Address: 820 SW ADAMS ST
City: Peoria
State: Illinois
ZIP Code: 61602-1623
Phone: (309) 223-4171

Authorized Official

Name: BRANDON M RUSSELL
Title: FOUNDER & CEO
Phone: (309) 223-4171

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Adult Mental Health — Adult Mental Health	261QM0850X
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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