Healthcare Provider Details

I. General information

NPI: 1649903261
Provider Name (Legal Business Name): CHRISTIAN SOCIAL SERVICES OF ILLINOIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 SR 159 STE 4
GLEN CARBON IL
62034
US

IV. Provider business mailing address

8601 W MAIN ST
BELLEVILLE IL
62223-1719
US

V. Phone/Fax

Practice location:
  • Phone: 618-205-8402
  • Fax:
Mailing address:
  • Phone: 618-213-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GARY HUELSMAN
Title or Position: CEO
Credential:
Phone: 618-213-8700