Healthcare Provider Details

I. General information

NPI: 1003649484
Provider Name (Legal Business Name): CHRISTIAN COUNSELING NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4047 CENTER AVE
LYONS IL
60534-1315
US

IV. Provider business mailing address

4047 CENTER AVE
LYONS IL
60534-1315
US

V. Phone/Fax

Practice location:
  • Phone: 773-425-1232
  • Fax:
Mailing address:
  • Phone: 773-425-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. BLAKE M ADAMS
Title or Position: EXECUTIVE DIRECTOR
Credential: LPC
Phone: 773-425-1232