Provider Demographics
NPI:1629259320
Name:CHRISTIAN COUNSELING CENTER / OSAF
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER / OSAF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DMIN,LCMFT
Authorized Official - Phone:316-264-8800
Mailing Address - Street 1:333 S GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1819
Mailing Address - Country:US
Mailing Address - Phone:316-264-8800
Mailing Address - Fax:316-264-8809
Practice Address - Street 1:333 S GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1819
Practice Address - Country:US
Practice Address - Phone:316-264-8800
Practice Address - Fax:316-264-8809
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHRISTIAN COUNSELING CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS116083OtherBCBSKS