| Organization Name: | TAZWOOD MENTAL HEALTH CENTER, INC. |
| NPI Number: | 1356466007 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVE WALTER MINGUS (CEO) |
| Mailing Address: | 111 W. Washington Street Suite 230 East Peoria |
| State: | IL US |
| Postal Code: | 616112560 |
| Phone Number: | 3096946462 |
| Fax Number: | 3096947812 |
| NPI Enumeration Date: | 03/20/2007 |
| NPI Last Update Date: | 12/10/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |