Provider Demographics
NPI:1922572148
Name:CHRISTIANNE JUDY LCSW LLC
Entity Type:Organization
Organization Name:CHRISTIANNE JUDY LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:314-518-7897
Mailing Address - Street 1:635 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2663
Mailing Address - Country:US
Mailing Address - Phone:314-518-7897
Mailing Address - Fax:
Practice Address - Street 1:635 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2663
Practice Address - Country:US
Practice Address - Phone:314-518-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty