Provider Demographics
NPI:1679885677
Name:CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES
Entity Type:Organization
Organization Name:CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD, PSYCHOLOGIST
Authorized Official - Phone:314-567-4994
Mailing Address - Street 1:9378 OLIVE BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-3222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9378 OLIVE BLVD STE 106
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-3222
Practice Address - Country:US
Practice Address - Phone:314-567-4994
Practice Address - Fax:314-567-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5873946103T00000X
MO00654103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3688245Medicaid