=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689460974
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BELLEVILLE COUNSELING ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 04/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4460 N ILLINOIS ST STE 1
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-1899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-277-7570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4460 N ILLINOIS ST STE 1
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62226-1899
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-277-7570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHLEEN HARVEY
-----------------------------------------------------
Credential | MSW LCSW
-----------------------------------------------------
Telephone | 618-277-7570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------