| The Center For Christian Counseling, Consultation And Training Inc. | |
|
5310 Wall Street Suite 500 Madison WI 53718 | |
| (608) 274-8294 | |
| (608) 274-8783 |
| Full Name | The Center For Christian Counseling, Consultation And Training Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5310 Wall Street, Madison, Wisconsin |
| Authorized Official Name and Position | Kevin Carl Randall (CLINICAL DIRECTOR/OWNER) |
| Authorized Official Contact | 6082748294 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Center For Christian Counseling, Consultation And Training Inc. 5310 Wall Street Suite 500 Madison WI 53718 Ph: (608) 274-8294 | The Center For Christian Counseling, Consultation And Training Inc. 5310 Wall Street Suite 500 Madison WI 53718 Ph: (608) 274-8294 |
| NPI Number | 1073703997 |
|---|---|
| Provider Enumeration Date | 07/26/2007 |
| Last Update Date | 06/16/2010 |
| Medicare PECOS PAC ID | 4385530104 |
|---|---|
| Medicare Enrollment ID | O20040226001001 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073703997 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Nadia S Damm |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1548417389 PECOS PAC ID: 1951467240 Enrollment ID: I20090312000105 |
| Provider Name | Frederick W Coleman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760601777 PECOS PAC ID: 0840473898 Enrollment ID: I20110329000307 |
| Provider Name | Lisa R Doyle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366715542 PECOS PAC ID: 7618229196 Enrollment ID: I20181010003731 |
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