Basic Information
| Provider Information | |||||||||
| NPI: | 1699725127 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHRISTIAN COUNSELING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1870 LEONARD ST NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495055650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169561122 | ||||||||
| FaxNumber: | 6169568033 | ||||||||
| Practice Location | |||||||||
| Address1: | 1870 LEONARD NE | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6169561122 | ||||||||
| FaxNumber: | 6169568033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 03/26/2012 | ||||||||
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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 | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.