NPIMap

Organization Active NPI

Belleville Area Special Services Cooperative

  • School Psychologist
  • Belleville, IL
National Provider Identifier
1679090997
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
School PsychologistTaxonomy code 103TS0200X
License
394137 Issued in IL
Legal business name
BELLEVILLE AREA SPECIAL SERVICES COOPERATIVE
Practice address
2411 Pathways Xing
Belleville, IL 62221-5885
Phone
(618) 355-4700
NPI assigned
Aug 28, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeff Daugherty
Title
Executive Director
Phone
(618) 355-4719

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
School PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TS0200X 394137 IL Primary

Addresses

Primary practice location

2411 Pathways Xing
Belleville, IL 62221-5885

Mailing address

2411 Pathways Xing
Belleville, IL 62221-5885
Phone (618) 355-4700

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1503878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679090997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 PATHWAYS XING",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215885",
            "telephone_number": "618-355-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 PATHWAYS XING",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215885",
            "telephone_number": "618-355-4700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVILLE AREA SPECIAL SERVICES COOPERATIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-28",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-355-4719"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, School",
            "state": "IL",
            "license": "394137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.