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General NPI Number Information
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NPI Number | 1720135932
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Entity Type | Organization
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Legal Business Name | CLINIC FOR CHRISTIAN COUNSELING LLC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 3410 OAKWOOD MALL DR STE 700
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2617
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Country | US
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Telephone | 715-832-1678
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Fax | 715-832-6680
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Provider Business Mailing Address
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Address Line | 3410 OAKWOOD MALL DR STE 700
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City | EAU CLAIRE
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State | WI
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Zip | 54701-2617
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Country | US
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Telephone | 715-832-1678
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Fax | 715-832-6580
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KIMBERLY JEAN STEIN
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Credential | LPC
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Telephone | 715-832-1678
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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 | 686-125
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License Number State | WI
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