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General NPI Number Information
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NPI Number | 1124263199
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Entity Type | Organization
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Legal Business Name | CATHOLIC SOCIAL SERVICE
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Dates
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Enumeration Date | 12/04/2008
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Last Update Date | 12/04/2008
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Provider Practice Location Address
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Address Line | 8601 W MAIN ST
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City | BELLEVILLE
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State | IL
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Zip | 62223-1719
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Country | US
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Telephone | 618-394-5900
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Fax |
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Provider Business Mailing Address
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Address Line | 8601 W MAIN ST
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City | BELLEVILLE
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State | IL
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Zip | 62223-1719
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Country | US
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Telephone | 618-394-5900
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MRS. LINDA SUE HEAP
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Credential | M.A., L.C.P.C.
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Telephone | 618-394-5900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180003289
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License Number State | IL
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