Provider Demographics
NPI:1720135932
Name:CLINIC FOR CHRISTIAN COUNSELING LLC
Entity Type:Organization
Organization Name:CLINIC FOR CHRISTIAN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:715-832-1678
Mailing Address - Street 1:3410 OAKWOOD MALL DR STE 700
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-2617
Mailing Address - Country:US
Mailing Address - Phone:715-832-1678
Mailing Address - Fax:715-832-6580
Practice Address - Street 1:3410 OAKWOOD MALL DR STE 700
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-2617
Practice Address - Country:US
Practice Address - Phone:715-832-1678
Practice Address - Fax:715-832-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI686-125251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39285200Medicaid
WI39285200Medicaid