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General NPI Number Information
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NPI Number | 1295960516
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Entity Type | Organization
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Legal Business Name | CHRISTIAN CLINICAL CONCEPTS, LLC
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Dates
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Enumeration Date | 05/17/2009
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 5700 E FRANKLIN RD SUITES 220 A&H
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City | NAMPA
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State | ID
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Zip | 83687-8497
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Country | US
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Telephone | 208-475-1875
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Fax | 208-475-1876
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Provider Business Mailing Address
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Address Line | 5700 E FRANKLIN RD SUITES 220 A&H
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City | NAMPA
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State | ID
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Zip | 83687-8497
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Country | US
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Telephone | 208-475-1875
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Fax | 208-475-1876
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Authorized Official
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Title or Position | MANAGER/CEO
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Name | BRIAN LYNN RAYMOND
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Credential | LMSW
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Telephone | 208-571-2723
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LMSW-28829
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License Number State | ID
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