Provider Demographics
NPI:1346756459
Name:CCC OF WESTERN KENTUCKY
Entity Type:Organization
Organization Name:CCC OF WESTERN KENTUCKY
Other - Org Name:CHRISTIAN COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMFT
Authorized Official - Phone:270-442-5738
Mailing Address - Street 1:PO BOX 8211
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-8211
Mailing Address - Country:US
Mailing Address - Phone:270-442-5738
Mailing Address - Fax:270-442-3172
Practice Address - Street 1:2820 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4170
Practice Address - Country:US
Practice Address - Phone:270-442-5738
Practice Address - Fax:270-442-3172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-27
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105399101YM0800X
KY105699101YM0800X
KY104561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty