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General NPI Number Information
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NPI Number | 1669897591
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Entity Type | Organization
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Legal Business Name | CHRISTIAN COUNSELING SERVICES
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Dates
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Enumeration Date | 03/01/2014
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Last Update Date | 03/01/2014
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Provider Practice Location Address
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Address Line | 100 S IOWA AVE 100 S IOWA AVE
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City | FRUITLAND
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State | ID
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Zip | 83619-2644
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Country | US
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Telephone | 208-452-4378
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Fax | 208-452-4378
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Provider Business Mailing Address
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Address Line | 100 S IOWA AVE
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City | FRUITLAND
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State | ID
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Zip | 83619-2644
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Country | US
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Telephone | 208-452-4378
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Fax | 208-452-4378
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Authorized Official
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Title or Position | COUNSELOR
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Name | JANICE STRAMEL
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Credential | 2084524378
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Telephone | 208-452-4378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LCPC3857
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License Number State | ID
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