Provider Demographics
NPI:1942386131
Name:CENTER FOR CHRISTIAN COUNSELING & TRNG
Entity Type:Organization
Organization Name:CENTER FOR CHRISTIAN COUNSELING & TRNG
Other - Org Name:CENTER FOR COUNSELING & PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:DCC PHD
Authorized Official - Phone:321-269-0404
Mailing Address - Street 1:350 N WASHINGTON AVE
Mailing Address - Street 2:SUITE L
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-5806
Mailing Address - Country:US
Mailing Address - Phone:321-269-0404
Mailing Address - Fax:321-269-8173
Practice Address - Street 1:350 N WASHINGTON AVE
Practice Address - Street 2:SUITE L
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-5806
Practice Address - Country:US
Practice Address - Phone:321-269-0404
Practice Address - Fax:321-269-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty