Provider Demographics
NPI:1417299215
Name:CHRISTIAN COUNSELING MINISTRIES
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING MINISTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ALTIG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-694-0984
Mailing Address - Street 1:756 OFFICERS ROW
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3845
Mailing Address - Country:US
Mailing Address - Phone:360-694-0984
Mailing Address - Fax:360-567-0709
Practice Address - Street 1:756 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3845
Practice Address - Country:US
Practice Address - Phone:360-694-0984
Practice Address - Fax:360-567-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60255260911251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60255260911OtherUNIVERSAL BUSINESS IDENTIFIER