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General NPI Number Information
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NPI Number | 1902199854
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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 | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 603 EAST AVE
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City | HOLDREGE
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State | NE
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Zip | 68949-2314
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Country | US
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Telephone | 308-995-9399
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Fax | 308-995-9399
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Provider Business Mailing Address
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Address Line | 603 EAST AVE PO BOX 56
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City | HOLDREGE
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State | NE
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Zip | 68949-2314
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Country | US
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Telephone | 308-995-9399
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Fax | 308-995-9399
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. ED PUTNAM
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Credential | MA, LMHP, CPC
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Telephone | 308-995-9399
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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 | 8749
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License Number State | NE
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