Provider Demographics
NPI:1598103087
Name:ROYAL CENTER UNITED METHODIST CHURCH
Entity Type:Organization
Organization Name:ROYAL CENTER UNITED METHODIST CHURCH
Other - Org Name:ROYAL CENTER UNITED METHODIST CHURCH COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:K
Authorized Official - Last Name:RANS
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:574-307-4108
Mailing Address - Street 1:100 KRAMER ST
Mailing Address - Street 2:BOX 397
Mailing Address - City:ROYAL CENTER
Mailing Address - State:IN
Mailing Address - Zip Code:46978-0397
Mailing Address - Country:US
Mailing Address - Phone:574-307-4108
Mailing Address - Fax:
Practice Address - Street 1:100 KRAMER ST
Practice Address - Street 2:BOX 397
Practice Address - City:ROYAL CENTER
Practice Address - State:IN
Practice Address - Zip Code:46978-0397
Practice Address - Country:US
Practice Address - Phone:574-307-4108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004534A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty