=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225075583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN COUNSELING MINISTRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 803 OVERLAND TRAIL
-----------------------------------------------------
City | ENID
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-242-5683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 803 OVERLAND TRAIL
-----------------------------------------------------
City | ENID
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73703
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-242-5683
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | MR. STEVE K MEGLI
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 580-242-5683
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 274
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------