Provider Demographics
NPI:1154511798
Name:JUDITH C CHRISTENSEN, LLC
Entity Type:Organization
Organization Name:JUDITH C CHRISTENSEN, LLC
Other - Org Name:LINCOLN MENTAL HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-955-1836
Mailing Address - Street 1:809 CENTRAL AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-3936
Mailing Address - Country:US
Mailing Address - Phone:515-955-1836
Mailing Address - Fax:515-955-7115
Practice Address - Street 1:809 CENTRAL AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-3936
Practice Address - Country:US
Practice Address - Phone:515-955-1836
Practice Address - Fax:515-955-7115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01153251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA=========Medicaid