Provider Demographics
NPI:1982060471
Name:TRUE VINE CHRISTIAN SERVICES INC
Entity Type:Organization
Organization Name:TRUE VINE CHRISTIAN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBOSA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-892-5995
Mailing Address - Street 1:4191 CRESCENT DR
Mailing Address - Street 2:STE D
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1000
Mailing Address - Country:US
Mailing Address - Phone:314-892-5995
Mailing Address - Fax:
Practice Address - Street 1:4191 CRESCENT DR
Practice Address - Street 2:STE D
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-1000
Practice Address - Country:US
Practice Address - Phone:314-892-5995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-13
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty