Provider Demographics
NPI:1215283585
Name:CHURCHILL FAMILY COUNSELING
Entity type:Organization
Organization Name:CHURCHILL FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CHURCHILL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:636-359-6445
Mailing Address - Street 1:1428 N STATE HIGHWAY 47
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1375
Mailing Address - Country:US
Mailing Address - Phone:636-359-6445
Mailing Address - Fax:636-456-6216
Practice Address - Street 1:1428 N STATE HIGHWAY 47
Practice Address - Street 2:SUITE A
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1375
Practice Address - Country:US
Practice Address - Phone:636-359-6445
Practice Address - Fax:636-456-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005010044101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty