Provider Demographics
NPI:1477337145
Name:KAINOS CENTER FOR ECCLESIAL PSYCHOLOGY, INC
Entity Type:Organization
Organization Name:KAINOS CENTER FOR ECCLESIAL PSYCHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DALLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, EMDR
Authorized Official - Phone:331-806-7511
Mailing Address - Street 1:26W068 JEWELL RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3931
Mailing Address - Country:US
Mailing Address - Phone:331-806-7511
Mailing Address - Fax:
Practice Address - Street 1:26W068 JEWELL RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3931
Practice Address - Country:US
Practice Address - Phone:331-806-7511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health