Provider Demographics
NPI:1225344393
Name:ADVOCATE CHRISTIAN COUNSELING, INC
Entity Type:Organization
Organization Name:ADVOCATE CHRISTIAN COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:L.
Authorized Official - Middle Name:REED
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S
Authorized Official - Phone:972-802-2845
Mailing Address - Street 1:PO BOX 3031
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-3031
Mailing Address - Country:US
Mailing Address - Phone:972-802-2845
Mailing Address - Fax:
Practice Address - Street 1:12612 FM 1641
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-7604
Practice Address - Country:US
Practice Address - Phone:972-802-2845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180002225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty