=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417212804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2012
-----------------------------------------------------
Last Update Date | 07/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2699 STIRLING RD STE A106
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-674-2306
-----------------------------------------------------
Fax | 954-674-2307
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2699 STIRLING RD STE A106
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33312-6543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-674-2306
-----------------------------------------------------
Fax | 954-674-2307
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. HAROLD ANTHONY VIEUX
-----------------------------------------------------
Credential | LCMFT
-----------------------------------------------------
Telephone | 954-674-2306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LCMFT0350020512
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------