Provider Demographics
NPI:1225312689
Name:ELLIS-CHRISTENSEN, PATRICIA CLARE (MFTI #IMF81274)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:CLARE
Last Name:ELLIS-CHRISTENSEN
Suffix:
Gender:F
Credentials:MFTI #IMF81274
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S E ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5175
Mailing Address - Country:US
Mailing Address - Phone:707-284-3444
Mailing Address - Fax:707-978-3029
Practice Address - Street 1:319 S E ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5175
Practice Address - Country:US
Practice Address - Phone:707-284-3444
Practice Address - Fax:707-978-3029
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist