| Doctor Name: | MS. TINA MARIE CHURCHILL |
| NPI Number: | 1124276563 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC |
| License Number: | 2005010044 |
| Business Practice Address: | 1428 N. Highway 47 Suite A Warrenton, MO - 633831375 |
| Business Phone Number: | 6363596445 |
| Business Fax Number: | 6364566216 |
| Mailing Address: | 1428 N. Highway 47, Suite A WARRENTON |
| State: | MO |
| Postal Code: | 633831375 |
| Phone Number: | 6363596445 |
| Fax Number: | 6364566216 |
| NPI Enumeration Date: | 08/27/2008 |
| NPI Last Update Date: | 09/05/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 2005010044 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |