Provider Demographics
NPI:1104009414
Name:CHRISTOS MINISTRIES COUNSELING
Entity Type:Organization
Organization Name:CHRISTOS MINISTRIES COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:262-787-2904
Mailing Address - Street 1:12970 W. BLUEMOUND RD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-787-2904
Mailing Address - Fax:262-787-2909
Practice Address - Street 1:12970 W BLUEMOUND RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2607
Practice Address - Country:US
Practice Address - Phone:262-787-2904
Practice Address - Fax:262-787-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2774-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty