Provider Demographics
NPI:1740264241
Name:CARLIN, CHRISTOPHER J (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:CARLIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22901 S RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PECULIAR
Mailing Address - State:MO
Mailing Address - Zip Code:64078-0195
Mailing Address - Country:US
Mailing Address - Phone:417-321-4881
Mailing Address - Fax:866-223-4072
Practice Address - Street 1:22901 S RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:PECULIAR
Practice Address - State:MO
Practice Address - Zip Code:64078-0195
Practice Address - Country:US
Practice Address - Phone:417-321-4881
Practice Address - Fax:866-223-4072
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014377103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1740264241Medicaid
11461940OtherCAQH #
MOMA3108001OtherMEDICARE PTAN
MO1740264241Medicaid