Provider Demographics
NPI:1992907216
Name:CHRISTIAN COUNSELING CENTER OF MADISON CO., INC.
Entity type:Organization
Organization Name:CHRISTIAN COUNSELING CENTER OF MADISON CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENDON
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-643-6017
Mailing Address - Street 1:501 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-3430
Mailing Address - Country:US
Mailing Address - Phone:765-643-6017
Mailing Address - Fax:
Practice Address - Street 1:501 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-3430
Practice Address - Country:US
Practice Address - Phone:765-643-6017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health