Doctor Name: | MR. JOHN CHRISTIANSON |
NPI Number: | 1033584594 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.ED. |
License Number: | 303778 |
Business Practice Address: | 725 Center Ave Suite 5 Moorhead, MN - 565601958 |
Business Phone Number: | 2182871500 |
Business Fax Number: | 2182871267 |
Mailing Address: | 725 Center Ave, Suite 5 MOORHEAD |
State: | MN |
Postal Code: | 565601958 |
Phone Number: | 2182871500 |
Fax Number: | 2182871267 |
NPI Enumeration Date: | 12/09/2015 |
NPI Last Update Date: | 12/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 303778 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |