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General NPI Number Information
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NPI Number | 1487994679
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Entity Type | Organization
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Legal Business Name | LIGHTRISE FAMILY CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 02/25/2013
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Last Update Date | 02/25/2013
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Provider Practice Location Address
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Address Line | 265 EXCHANGE DR SUITE 105
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6230
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Country | US
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Telephone | 224-286-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 265 EXCHANGE DR SUITE 105
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-6230
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Country | US
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Telephone | 224-286-4673
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Fax |
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Authorized Official
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Title or Position | NCCA LICENSED PASTORAL COUNSELOR
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Name | MR. MADISON C BERESFORD
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Credential | MIN., B.C.M.F.
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Telephone | 224-286-4673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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