Provider Demographics
NPI:1114100864
Name:HERMANSEN, CHRISTENA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTENA
Middle Name:MARIE
Last Name:HERMANSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 40TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-1529
Mailing Address - Country:US
Mailing Address - Phone:612-865-1169
Mailing Address - Fax:
Practice Address - Street 1:10425 40TH AVE N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-1529
Practice Address - Country:US
Practice Address - Phone:612-865-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1606106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist