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General NPI Number Information
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NPI Number | 1588829949
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING AND RESOURCE CONSULTANTS,LLC
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Dates
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Enumeration Date | 07/25/2008
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Last Update Date | 07/25/2008
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Provider Practice Location Address
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Address Line | 3620 FINNEY AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-3902
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Country | US
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Telephone | 314-531-9946
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Fax |
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Provider Business Mailing Address
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Address Line | 3620 FINNEY AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-3902
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Country | US
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Telephone | 314-531-9946
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Fax |
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Authorized Official
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Title or Position | PRESIDENT,
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Name | DR. DOUGLASS PETTY
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Credential | PH.D
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Telephone | 314-531-9946
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC0020585
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License Number State | MO
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