Provider Demographics
NPI:1205915477
Name:CHRISTIAN PSYCHOLOGICAL SERVICES, P.C.
Entity type:Organization
Organization Name:CHRISTIAN PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:WARNER
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:260-336-3362
Mailing Address - Street 1:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-0414
Mailing Address - Country:US
Mailing Address - Phone:260-336-3362
Mailing Address - Fax:260-768-7114
Practice Address - Street 1:245 N. MORTON ST.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-0414
Practice Address - Country:US
Practice Address - Phone:260-336-3362
Practice Address - Fax:260-768-7114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041285A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000388789OtherANTHEM BC/BS
IN200176640BMedicaid
IN234600Medicare ID - Type Unspecified
INS00038Medicare UPIN