MEDICARE: CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES

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	103T00000X	Psychologist	5873946	TN
2	103T00000X	Psychologist	00654	MO

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	:	1679885677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN PSYCHOLOGICAL & FAMILY SERVICES

Provider Business Mailing Address
First Line	:	9378 OLIVE BLVD STE 106
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9378 OLIVE BLVD STE 106
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63132-3222
Country	:	US
Telephone Number	:	314-567-4994
Fax Number	:	314-567-8581

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	JOHN THOMAS TRIMBLE SR.
Credential	:	PHD, PSYCHOLOGIST
Telephone Number	:	314-567-4994

Provider Enumeration Date	:	07/07/2010
Last Update Date	:	07/07/2010

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