Provider Demographics
NPI:1477727006
Name:TRI-LAKES CHURCH
Entity Type:Organization
Organization Name:TRI-LAKES CHURCH
Other - Org Name:TRI-LAKES RELATIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:PINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-339-4041
Mailing Address - Street 1:2527 STATE HIGHWAY 248
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9240
Mailing Address - Country:US
Mailing Address - Phone:417-339-4041
Mailing Address - Fax:417-336-0909
Practice Address - Street 1:2527 STATE HIGHWAY 248
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-9240
Practice Address - Country:US
Practice Address - Phone:417-339-4041
Practice Address - Fax:417-336-0909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI-LAKES CHURCH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01240251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health