MEDICARE: CHRISTIAN PSYCHOTHERAPY RESOURCES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	001974	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487621827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN PSYCHOTHERAPY RESOURCES, INC.

Provider Business Mailing Address
First Line	:	115 MOSS SIDE DR
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30607-2108
Country	:	US
Telephone Number	:	706-308-7403
Fax Number	:	706-310-6907

Provider Business Practice Location Address
First Line	:	1360 CADUCEUS WAY STE 102
Second Line	:
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	706-282-8442
Fax Number	:	706-310-6907

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. JONATHAN CRAWFORD ROBINSON
Credential	:	PH.D.
Telephone Number	:	706-549-5248

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/21/2022

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