Healthcare Provider Details

I. General information

NPI: 1902973910
Provider Name (Legal Business Name): CATHOLIC SOCIAL SERVICES OF SOUTHERN ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W MAIN ST SUITE 201
BELLEVILLE IL
62223-1719
US

IV. Provider business mailing address

5213 SCHOLLMEYER AVE.
ST. LOUIS MO
63109
US

V. Phone/Fax

Practice location:
  • Phone: 618-394-5900
  • Fax: 618-394-5909
Mailing address:
  • Phone: 314-752-7138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. GARY HUELSMANN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 618-394-5900