Provider Demographics
NPI:1104201326
Name:ADVANCED CHRISTIAN COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED CHRISTIAN COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUNTHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:LLP
Authorized Official - Phone:231-633-4357
Mailing Address - Street 1:22746 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:MI
Mailing Address - Zip Code:49688-8584
Mailing Address - Country:US
Mailing Address - Phone:231-633-4357
Mailing Address - Fax:
Practice Address - Street 1:3491 HARTMAN RD
Practice Address - Street 2:#C
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-6999
Practice Address - Country:US
Practice Address - Phone:231-633-4357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health