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General NPI Number Information
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NPI Number | 1902973910
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Entity Type | Organization
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Legal Business Name | CATHOLIC SOCIAL SERVICES OF SOUTHERN ILLINOIS
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8601 W MAIN ST SUITE 201
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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 | 618-394-5909
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Provider Business Mailing Address
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Address Line | 5213 SCHOLLMEYER AVE.
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City | ST. LOUIS
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State | MO
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Zip | 63109
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Country | US
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Telephone | 314-752-7138
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. GARY HUELSMANN
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Credential | LCSW
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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 |
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License Number State | IL
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