Provider Demographics
NPI:1295960516
Name:CHRISTIAN CLINICAL CONCEPTS, LLC
Entity type:Organization
Organization Name:CHRISTIAN CLINICAL CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:208-571-2723
Mailing Address - Street 1:5700 E FRANKLIN RD
Mailing Address - Street 2:SUITES 220 A&H
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-8497
Mailing Address - Country:US
Mailing Address - Phone:208-475-1875
Mailing Address - Fax:208-475-1876
Practice Address - Street 1:5700 E FRANKLIN RD
Practice Address - Street 2:SUITES 220 A&H
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8497
Practice Address - Country:US
Practice Address - Phone:208-475-1875
Practice Address - Fax:208-475-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty