Provider Demographics
NPI:1588829949
Name:CHRISTIAN COUNSELING AND RESOURCE CONSULTANTS,LLC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING AND RESOURCE CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLASS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-531-9946
Mailing Address - Street 1:3620 FINNEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63113-3902
Mailing Address - Country:US
Mailing Address - Phone:314-531-9946
Mailing Address - Fax:
Practice Address - Street 1:3620 FINNEY AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63113-3902
Practice Address - Country:US
Practice Address - Phone:314-531-9946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOLC0020585251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health