Provider Demographics
NPI:1699515098
Name:CHRISTIAN COUNSELING SERVICE, LLC
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOCKERY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:812-883-4877
Mailing Address - Street 1:402 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-2122
Mailing Address - Country:US
Mailing Address - Phone:812-883-4877
Mailing Address - Fax:
Practice Address - Street 1:1645 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-9303
Practice Address - Country:US
Practice Address - Phone:812-883-4877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069976Medicaid