NPIMap

Organization Active NPI

Calvary Community Wesleyan Church

Doing business as Christian Counseling Center

  • Mental Health Counselor
  • Johnson City, NY
National Provider Identifier
1174984686
Registry record updated Jun 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
004573 Issued in NY
Legal business name
CALVARY COMMUNITY WESLEYAN CHURCH
Doing business as
Christian Counseling Center
Practice address
780 Harry L Dr
Johnson City, NY 13790
Phone
(607) 420-3020
Fax
(607) 729-7779
NPI assigned
Mar 10, 2016
Organization subpart
Yes
Parent organization
CALVARY COMMUNITY WESLYAN CHURCHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua J Nickels, MHCNPI 1871977488
Title
Executive Director
Phone
(607) 422-3020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 004573 NY Primary

Addresses

Primary practice location

780 Harry L Dr
Johnson City, NY 13790

Mailing address

780 Harry L Dr
Johnson City, NY 13790-1036
Phone (607) 422-3020

Other names 1

  • Christian Counseling Center Doing business as

National Provider Directory

National Provider Directory
Part of
Calvary Community Wesleyan Church

Locations

780 Harry L Dr
Johnson City, NY 13790
Phone (607) 422-3020

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1174984686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 HARRY L DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137901036",
            "telephone_number": "607-422-3020",
            "fax_number": "607-729-7779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 HARRY L DR",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "13790",
            "telephone_number": "607-420-3020",
            "fax_number": "607-729-7779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALVARY COMMUNITY WESLEYAN CHURCH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CALVARY COMMUNITY WESLYAN CHURCH",
        "enumeration_date": "2016-03-10",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "NICKELS",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "607-422-3020",
        "authorized_official_credential": "MHC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "004573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christian Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Christian Counseling Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.