1487783734 NPI number — CHRISTIAN COUNSELING

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487783734 NPI number — CHRISTIAN COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KARI KELLEY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487783734
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9651 W 153RD ST
Provider Second Line Business Mailing Address:
STE. 55
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-3773
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-357-6881
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9651 W 153RD ST
Provider Second Line Business Practice Location Address:
STE 55
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462-3773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-460-9650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KELLEY
Authorized Official First Name:
KARI
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDER/OWNER
Authorized Official Telephone Number:
708-460-9650

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180001829 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180001829 . This is a "STATE REGISTRATION NO." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0001632540 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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