Provider Demographics
NPI:1154539476
Name:CHRISMAN, EDWARD J JR (MDIV)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:J
Last Name:CHRISMAN
Suffix:JR
Gender:M
Credentials:MDIV
Other - Prefix:MR
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:CHRISMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MDIV, LMFT
Mailing Address - Street 1:1143 S 3RD ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2901
Mailing Address - Country:US
Mailing Address - Phone:502-581-1258
Mailing Address - Fax:
Practice Address - Street 1:1143 S 3RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2901
Practice Address - Country:US
Practice Address - Phone:502-581-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist