Provider Demographics
NPI:1376381657
Name:COUNSELING MINISTRY OF CHARLES DE FOUCAULD, INC.
Entity type:Organization
Organization Name:COUNSELING MINISTRY OF CHARLES DE FOUCAULD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, COUNSELING MINISTRY OF C
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:BRETT
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-361-4095
Mailing Address - Street 1:P.O. BOX 390
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93584-0390
Mailing Address - Country:US
Mailing Address - Phone:661-470-9410
Mailing Address - Fax:
Practice Address - Street 1:626 W. LANCASTER BLVD. #104
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-470-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty