Basic Information
| Provider Information | |||||||||
| NPI: | 1053445239 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHICAGO CHRISTIAN COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1251 | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169428060 | ||||||||
| FaxNumber: | 6169426690 | ||||||||
| Practice Location | |||||||||
| Address1: | 833 W LINCOLN HW STE 400 WEST | ||||||||
| Address2: | |||||||||
| City: | SCHEREVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169428060 | ||||||||
| FaxNumber: | 6169426690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SWISHER | ||||||||
| AuthorizedOfficialFirstName: | KIM | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 6169428060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC0700X | X | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.