Provider Demographics
NPI:1629655451
Name:KALAMAZOO CHRISTIAN COUNSELING
Entity Type:Organization
Organization Name:KALAMAZOO CHRISTIAN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GRIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MA, LLPC
Authorized Official - Phone:269-348-4331
Mailing Address - Street 1:5550 OAKLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-1113
Mailing Address - Country:US
Mailing Address - Phone:269-348-4331
Mailing Address - Fax:
Practice Address - Street 1:5550 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1113
Practice Address - Country:US
Practice Address - Phone:269-348-4331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health