Provider Demographics
NPI:1104862747
Name:BREIEL BLVD CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:BREIEL BLVD CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:EDDMSW, LISW, IMFT
Authorized Official - Phone:513-424-1887
Mailing Address - Street 1:2000 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-2979
Mailing Address - Country:US
Mailing Address - Phone:513-424-1887
Mailing Address - Fax:513-424-2720
Practice Address - Street 1:2000 N BREIEL BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-2979
Practice Address - Country:US
Practice Address - Phone:513-424-1887
Practice Address - Fax:513-424-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLISW-I0009561251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable