MEDICARE: CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LCMFT0350020512	FL

General Provider Information

NPI Number	:	1417212804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC

Provider Business Mailing Address
First Line	:	2699 STIRLING RD STE A106
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6543
Country	:	US
Telephone Number	:	954-674-2306
Fax Number	:	954-674-2307

Provider Business Practice Location Address
First Line	:	2699 STIRLING RD STE A106
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6543
Country	:	US
Telephone Number	:	954-674-2306
Fax Number	:	954-674-2307

Authorized Official
Title or Position	:	CEO
Name	:	DR. HAROLD ANTHONY VIEUX
Credential	:	LCMFT
Telephone Number	:	954-674-2306

Provider Enumeration Date	:	07/11/2012
Last Update Date	:	07/11/2012

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