Organization
HUMAN SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA JONES (BUSINESS MANAGER)
(618) 939-4444
Entity
Organization
Contact information
Practice address
228 BRADFORD LN STE 2, WATERLOO, IL 62298-3270
(618) 939-4444
Mailing address
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1059
(618) 939-4444
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IL
Enumeration date
09/20/2019
Last updated
09/20/2019
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