Provider Demographics
NPI:1033442132
Name:COMMUNITY CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:COMMUNITY CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:COKER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,BC, LCSW
Authorized Official - Phone:417-339-2535
Mailing Address - Street 1:170 WINDY RDG
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:MO
Mailing Address - Zip Code:65672-5724
Mailing Address - Country:US
Mailing Address - Phone:417-339-2535
Mailing Address - Fax:
Practice Address - Street 1:170 WINDY RDG
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:MO
Practice Address - Zip Code:65672-5724
Practice Address - Country:US
Practice Address - Phone:417-339-2535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-08
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO065595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000078485Medicare UPIN