1487621827 NPI number — CHRISTIAN PSYCHOTHERAPY RESOURCES, INC.

Table of content: (NPI 1487621827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487621827 NPI number — CHRISTIAN PSYCHOTHERAPY RESOURCES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN PSYCHOTHERAPY RESOURCES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
JONATHAN C. ROBINSON, PH.D., P.C.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487621827
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1360 CADUCEUS WAY STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30677-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-282-8442
Provider Business Practice Location Address Fax Number:
706-310-6907
Provider Enumeration Date:
03/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
CRAWFORD
Authorized Official Title or Position:
LICENSED CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
706-549-5248

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  001974 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00693437A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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