Provider Demographics
NPI:1487783734
Name:CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BCPC,LCPC,CADC
Authorized Official - Phone:708-460-9650
Mailing Address - Street 1:9651 W 153RD ST
Mailing Address - Street 2:STE. 55
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3773
Mailing Address - Country:US
Mailing Address - Phone:708-357-6881
Mailing Address - Fax:
Practice Address - Street 1:9651 W 153RD ST
Practice Address - Street 2:STE 55
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3773
Practice Address - Country:US
Practice Address - Phone:708-460-9650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180001829101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180001829OtherSTATE REGISTRATION NO.
IL0001632540OtherBLUE CROSS BLUE SHIELD