Provider Demographics
NPI:1033217229
Name:CHRISTENSEN, DEBORAH AUSTIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:AUSTIN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12660 FORT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9303
Mailing Address - Country:US
Mailing Address - Phone:801-816-1801
Mailing Address - Fax:801-501-0249
Practice Address - Street 1:12660 FORT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9303
Practice Address - Country:US
Practice Address - Phone:801-816-1801
Practice Address - Fax:801-501-0249
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89-115803-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTR61069Medicare UPIN