Provider Demographics
NPI:1164736088
Name:CHRISTIAN COUNSELING ASSOCIATES LLC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEBNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:262-786-9184
Mailing Address - Street 1:17100 W NORTH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4436
Mailing Address - Country:US
Mailing Address - Phone:262-786-4665
Mailing Address - Fax:262-786-1906
Practice Address - Street 1:17100 W NORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4436
Practice Address - Country:US
Practice Address - Phone:262-786-4665
Practice Address - Fax:262-786-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4444-125101YM0800X
WI2255057103T00000X
WI2134057103T00000X
WI2116057103T00000X
WI2044-57103T00000X
WI39971231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty