Provider Demographics
NPI:1003218819
Name:VICTOR'S S CROWN CHRISTIAN COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:VICTOR'S S CROWN CHRISTIAN COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-528-2192
Mailing Address - Street 1:571 VFW MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-4841
Mailing Address - Country:US
Mailing Address - Phone:573-528-2192
Mailing Address - Fax:
Practice Address - Street 1:571 VFW MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4841
Practice Address - Country:US
Practice Address - Phone:573-528-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-24
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011013510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty