Provider Demographics
NPI:1346538436
Name:CHRISTOPHER MINISTRIES, INC.
Entity Type:Organization
Organization Name:CHRISTOPHER MINISTRIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JUNGKURTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,LPC,LMHC,SAP
Authorized Official - Phone:615-636-7414
Mailing Address - Street 1:PO BOX 555
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37121-0555
Mailing Address - Country:US
Mailing Address - Phone:615-636-7414
Mailing Address - Fax:866-799-4512
Practice Address - Street 1:313B W DIVISION ST
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3207
Practice Address - Country:US
Practice Address - Phone:615-636-7414
Practice Address - Fax:866-799-4512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty