Macomb Mental Wellness LLC

NPI #1548863194 in Macomb, Illinois

Provider Information

NPI Number: 1548863194
Entity Type: Organization
Organization Name: Macomb Mental Wellness LLC
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Nov 17, 2020
Last Updated: Nov 17, 2020

Practice Location

Address: 210 S RANDOLPH ST
City: Macomb
State: Illinois
ZIP Code: 61455-3828
Phone: (217) 779-6063

Authorized Official

Name: JOSEPH WILLIAM PROCTOR, PSY.D
Title: CLINICAL PSYCHOLOGIST
Phone: (217) 779-6063

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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