Provider Demographics
NPI:1174776561
Name:THE CENTER FOR CHRISTIAN PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:THE CENTER FOR CHRISTIAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MDIV, LP
Authorized Official - Phone:651-633-5290
Mailing Address - Street 1:2780 SNELLING AVE N
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7115
Mailing Address - Country:US
Mailing Address - Phone:651-633-5290
Mailing Address - Fax:651-633-5238
Practice Address - Street 1:2780 SNELLING AVE N
Practice Address - Street 2:SUITE 104
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7115
Practice Address - Country:US
Practice Address - Phone:651-633-5290
Practice Address - Fax:651-633-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)