Provider Demographics
NPI:1073788618
Name:CHRISTIAN COUNSELING CENTER AT FIRST LUTHERAN CHURCH
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER AT FIRST LUTHERAN CHURCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRO CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PCC/S
Authorized Official - Phone:419-447-8111
Mailing Address - Street 1:PO BOX 713
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-0713
Mailing Address - Country:US
Mailing Address - Phone:419-447-8111
Mailing Address - Fax:419-447-8158
Practice Address - Street 1:300 MELMORE ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3535
Practice Address - Country:US
Practice Address - Phone:419-447-8111
Practice Address - Fax:419-447-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty