Provider Demographics
NPI:1972681922
Name:CHRISTOPHER & ASSOCIATES EVALUATION &COUNSELING CENTER INC
Entity Type:Organization
Organization Name:CHRISTOPHER & ASSOCIATES EVALUATION &COUNSELING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, HSPP
Authorized Official - Phone:812-523-0386
Mailing Address - Street 1:415 S WALNUT ST STE 215
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2993
Mailing Address - Country:US
Mailing Address - Phone:812-523-0386
Mailing Address - Fax:
Practice Address - Street 1:415 S WALNUT ST STE 215
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2993
Practice Address - Country:US
Practice Address - Phone:812-523-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041655A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN209760Medicare ID - Type Unspecified