Provider Demographics
NPI:1417212804
Name:CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC
Entity Type:Organization
Organization Name:CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC
Other - Org Name:SHILOH CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:954-674-2306
Mailing Address - Street 1:2699 STIRLING RD STE A106
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-6543
Mailing Address - Country:US
Mailing Address - Phone:954-674-2306
Mailing Address - Fax:954-674-2307
Practice Address - Street 1:2699 STIRLING RD STE A106
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-6543
Practice Address - Country:US
Practice Address - Phone:954-674-2306
Practice Address - Fax:954-674-2307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONFERENCE OF CHRISTIAN PASTORS AND MINISTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCMFT0350020512106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty