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General NPI Number Information
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NPI Number | 1073788618
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING CENTER AT FIRST LUTHERAN CHURCH
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 300 MELMORE ST
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City | TIFFIN
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State | OH
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Zip | 44883-3535
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Country | US
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Telephone | 419-447-8111
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Fax | 419-447-8158
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Provider Business Mailing Address
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Address Line | PO BOX 713
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City | TIFFIN
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State | OH
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Zip | 44883-0713
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Country | US
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Telephone | 419-447-8111
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Fax | 419-447-8158
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Authorized Official
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Title or Position | DIRECTOR/PRO CLINICAL COUNSELOR
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Name | JENNIFER KAY DAMM
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Credential | PCC/S
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Telephone | 419-447-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E.0003749
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License Number State | OH
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