Provider Demographics
NPI:1073703997
Name:THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION AND TRAINING INC.
Entity Type:Organization
Organization Name:THE CENTER FOR CHRISTIAN COUNSELING, CONSULTATION AND TRAINING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:608-274-8294
Mailing Address - Street 1:5310 WALL STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53718
Mailing Address - Country:US
Mailing Address - Phone:608-274-8294
Mailing Address - Fax:608-274-8783
Practice Address - Street 1:5310 WALL STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53718
Practice Address - Country:US
Practice Address - Phone:608-274-8294
Practice Address - Fax:608-274-8783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)