| Organization Name: | CHRISTIAN LIFE COUNSELING LCC |
| NPI Number: | 1023056009 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIC DON SEYBOLD (PSYCHOLOGIST) |
| Mailing Address: | 12690 W North Ave Brookfield |
| State: | WI US |
| Postal Code: | 530054636 |
| Phone Number: | 2627851008 |
| Fax Number: | 2627850644 |
| NPI Enumeration Date: | 06/03/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 2494-057 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |