Provider Demographics
NPI:1396883732
Name:THE JOHN ENGLE CHRISTIAN COUNSELING CENTER
Entity type:Organization
Organization Name:THE JOHN ENGLE CHRISTIAN COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-896-4357
Mailing Address - Street 1:225 LUDLOW ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2922
Mailing Address - Country:US
Mailing Address - Phone:513-896-4357
Mailing Address - Fax:513-896-1050
Practice Address - Street 1:225 LUDLOW ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2922
Practice Address - Country:US
Practice Address - Phone:513-896-4357
Practice Address - Fax:513-896-1050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHJO9288521101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJOSW10284OtherKRISTI JOHNSON MSW, LISW
OHHESW17111OtherJERRY HEATHERLY MDIV LISW
OHOVSW19101OtherLEANNE J. MYERS MSW, LISW