Provider Demographics
NPI:1972713758
Name:CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES
Entity Type:Organization
Organization Name:CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST PRES CPFS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TRIMBLE
Authorized Official - Suffix:SR
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-567-4994
Mailing Address - Street 1:9378 OLIVE BLVD
Mailing Address - Street 2:STE 314
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132
Mailing Address - Country:US
Mailing Address - Phone:314-567-4994
Mailing Address - Fax:314-567-8581
Practice Address - Street 1:9378 OLIVE BLVD
Practice Address - Street 2:STE 314
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132
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:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOP654MO103T00000X
TNP257103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3688245Medicaid
TN3688245Medicaid