MEDICARE: CHINO VALLEY BIBLE CHURCH

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	251V00000X	Voluntary or Charitable Agency

General Provider Information

NPI Number	:	1871288704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHINO VALLEY BIBLE CHURCH

Provider Business Mailing Address
First Line	:	410 STACEY DR
Second Line	:
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-6497
Country	:	US
Telephone Number	:	602-663-1491
Fax Number	:

Provider Business Practice Location Address
First Line	:	1578 N HWY 89 STE B
Second Line	:
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-7624
Country	:	US
Telephone Number	:	602-663-1491
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	STACIE BROWN
Credential	:	LPC, PH.D.
Telephone Number	:	602-663-1491

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	04/06/2023

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Directions to “CHINO VALLEY BIBLE CHURCH ” Practice Location

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