Provider Demographics
NPI:1689616062
Name:CHRISTIAN COUNSELING CENTER OF WICHITA, INC
Entity Type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER OF WICHITA, INC
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:LMFT
Authorized Official - Phone:316-264-8800
Mailing Address - Street 1:333 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67211-1844
Mailing Address - Country:US
Mailing Address - Phone:316-264-8800
Mailing Address - Fax:316-264-8809
Practice Address - Street 1:333 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-1844
Practice Address - Country:US
Practice Address - Phone:316-264-8800
Practice Address - Fax:316-264-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS642101YA0400X
KS643101YA0400X
101YM0800X, 101YP2500X
KS22711041C0700X
KS19571041C0700X
KS25261041C0700X
KS622106H00000X
KS219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty