Provider Demographics
NPI:1609131192
Name:COMPASSIONATE CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:COMPASSIONATE CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOETJE-BALDER
Authorized Official - Suffix:
Authorized Official - Credentials:MA LLP
Authorized Official - Phone:231-799-8182
Mailing Address - Street 1:5353 GRAND HAVEN RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-5985
Mailing Address - Country:US
Mailing Address - Phone:231-799-8182
Mailing Address - Fax:231-799-8183
Practice Address - Street 1:5353 GRAND HAVEN RD STE B
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-5985
Practice Address - Country:US
Practice Address - Phone:231-799-8182
Practice Address - Fax:231-799-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011468251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health