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General NPI Number Information
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NPI Number | 1992161350
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Entity Type | Organization
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Legal Business Name | CHRISTIAN RECOVERY COUNSELING
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 330 112TH AVE NE, STE 302
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-289-9589
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Fax | 425-576-0654
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Provider Business Mailing Address
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Address Line | 2820 NORTHUP WAY STE 105
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-289-9589
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Fax |
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Authorized Official
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Title or Position | MEMBER MANAGER
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Name | CHRISTOPHER A CHANDLER
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Credential | MA, LMHC
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Telephone | 14252899589
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH 00011043
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License Number State | WA
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