Provider Demographics
NPI:1700972908
Name:CHRISTOS COUNSELING
Entity Type:Organization
Organization Name:CHRISTOS COUNSELING
Other - Org Name:CHRISTOS MINISTRIES, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LMFT
Authorized Official - Phone:262-787-2904
Mailing Address - Street 1:12970 W. BLUEMOUND ROAD
Mailing Address - Street 2:#105
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122
Mailing Address - Country:US
Mailing Address - Phone:262-787-2904
Mailing Address - Fax:262-787-2909
Practice Address - Street 1:12970 W. BLUEMOUND ROAD
Practice Address - Street 2:#105
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122
Practice Address - Country:US
Practice Address - Phone:262-787-2904
Practice Address - Fax:262-787-2909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WILCSW 20271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty