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General NPI Number Information
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NPI Number | 1245795251
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Entity Type | Organization
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Legal Business Name | HUMAN SUPPORT SERVICES
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Dates
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Enumeration Date | 02/04/2019
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 960 COLUMBIA CTR
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City | COLUMBIA
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State | IL
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Zip | 62236-2545
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Country | US
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Telephone | 618-939-4444
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Fax | 618-939-4181
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Provider Business Mailing Address
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Address Line | 988 N ILLINOIS ROUTE 3
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City | WATERLOO
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State | IL
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Zip | 62298-1059
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Country | US
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Telephone | 619-393-4444
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MELISSA JONES
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Credential |
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Telephone | 618-939-4444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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