MEDICARE: CHRISTIAN COUNSELING CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor
3	101YP1600X	Pastoral Counselor
4	104100000X	Social Worker
5	106H00000X	Marriage & Family Therapist
6	101Y00000X	Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194891275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN COUNSELING CENTER

Provider Business Mailing Address
First Line	:	1060 W. BUSCH BLVD
Second Line	:	STE 104
City	:	TAMPA
State	:	FL
Zip	:	33612-7707
Country	:	US
Telephone Number	:	813-935-3917
Fax Number	:	813-985-5840

Provider Business Practice Location Address
First Line	:	1060 W. BUSCH BLVD
Second Line	:	STE 104
City	:	TAMPA
State	:	FL
Zip	:	33612-7707
Country	:	US
Telephone Number	:	813-935-3917
Fax Number	:	813-935-5840

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. TOM BILES
Credential	:
Telephone Number	:	813-935-3839

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	04/30/2009

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Directions to “CHRISTIAN COUNSELING CENTER ” Practice Location

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