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
988 N ILLINOIS ROUTE 3, WATERLOO, IL 62298-1000
(618) 939-4444
(618) 939-4181
Mailing address
988 N ILLINOIS ROUTE 3, PO BOX 146, WATERLOO, IL 62298-1000
(618) 939-4444
(618) 939-4181
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
N/A
IL
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067-15560
BLUE CROSS BLUE SHIELD
IL
01
—
10B862
BLUE CROSS BLUE SHIELD
MO
Enumeration date
07/26/2006
Last updated
11/26/2018
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