=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679885677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2010
-----------------------------------------------------
Last Update Date | 07/07/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9378 OLIVE BLVD STE 106
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-567-4994
-----------------------------------------------------
Fax | 314-567-8581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9378 OLIVE BLVD STE 106
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63132-3222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/PRESIDENT
-----------------------------------------------------
Name | JOHN THOMAS TRIMBLE SR.
-----------------------------------------------------
Credential | PHD, PSYCHOLOGIST
-----------------------------------------------------
Telephone | 314-567-4994
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 5873946
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 00654
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------