Provider Demographics
NPI:1083051890
Name:CHRISTENSEN, MATTHEW ERIC (CSW)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ERIC
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 S KOMAS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1241
Mailing Address - Country:US
Mailing Address - Phone:801-587-7813
Mailing Address - Fax:
Practice Address - Street 1:650 S KOMAS DR STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1241
Practice Address - Country:US
Practice Address - Phone:801-587-7813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8617468-3502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker