Provider Demographics
NPI:1659461648
Name:CHRISTIAN COUNSELING SERVICE INC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:PASTOR
Authorized Official - Phone:845-344-1770
Mailing Address - Street 1:758 EAST MAIN ST SUITE #1
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940
Mailing Address - Country:US
Mailing Address - Phone:845-344-1770
Mailing Address - Fax:845-343-2222
Practice Address - Street 1:758 EAST MAIN ST SUITE #1
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-344-1770
Practice Address - Fax:845-343-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
330918Medicare UPIN
=========Medicare UPIN
04451357Medicare UPIN
WDW651Medicare ID - Type Unspecified
5400241Medicare UPIN
1035920Medicare UPIN
0411103Medicare UPIN