Provider Demographics
NPI:1003828278
Name:ZYCH, CHRISTINE CATHERINE (PSYD, LP, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:CATHERINE
Last Name:ZYCH
Suffix:
Gender:F
Credentials:PSYD, LP, LMFT
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:CATHERINE
Other - Last Name:ZYCH-OELLIEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:430 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-3783
Mailing Address - Country:US
Mailing Address - Phone:507-476-5462
Mailing Address - Fax:507-401-3021
Practice Address - Street 1:430 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-3783
Practice Address - Country:US
Practice Address - Phone:507-476-5462
Practice Address - Fax:507-401-3021
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2018-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1049106H00000X
MNLP5962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN441778000Medicaid