1023203254 NPI number — THE WOODLANDS CHRISTIAN COUNSELING CENTER, INC.

Table of content: DR. LYNNE MARIE KELLNER PSYD (NPI 1720522113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023203254 NPI number — THE WOODLANDS CHRISTIAN COUNSELING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WOODLANDS CHRISTIAN COUNSELING CENTER, INC.
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:
Provider Other Organization Name Type Code:
6
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:
1023203254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32826 CRESTLAKE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAGNOLIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77354-3234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-750-6078
Provider Business Mailing Address Fax Number:
281-252-3507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25325 BOROUGH PARK DR
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-750-6078
Provider Business Practice Location Address Fax Number:
281-252-3507
Provider Enumeration Date:
09/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ABLES
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PROFESSIONAL COUNSELLOR
Authorized Official Telephone Number:
281-750-6078

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  14391 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811908635 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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