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General NPI Number Information
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NPI Number | 1679623235
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Entity Type | Organization
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Legal Business Name | CORINTHIAN CHRISTIAN CENTER
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 667 VAN BUREN ST
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City | GARY
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State | IN
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Zip | 46402-2240
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Country | US
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Telephone | 219-885-5819
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Fax | 219-661-8892
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Provider Business Mailing Address
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Address Line | PO BOX 9135
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City | GARY
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State | IN
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Zip | 46402-9135
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Country | US
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Telephone | 219-885-5819
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Fax | 219-661-8892
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JAN GOLD
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Credential |
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Telephone | 219-662-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20040617A
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License Number State | IN
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