Provider Demographics
NPI:1487994679
Name:LIGHTRISE FAMILY CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:LIGHTRISE FAMILY CHRISTIAN COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NCCA LICENSED PASTORAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:C
Authorized Official - Last Name:BERESFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MIN, BCMF
Authorized Official - Phone:224-286-4673
Mailing Address - Street 1:265 EXCHANGE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6230
Mailing Address - Country:US
Mailing Address - Phone:224-286-4673
Mailing Address - Fax:
Practice Address - Street 1:265 EXCHANGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6230
Practice Address - Country:US
Practice Address - Phone:224-286-4673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty