Provider Demographics
NPI:1225596778
Name:CHRISTIANSON, MALLEY ELIZABETH (LPCC)
Entity Type:Individual
Prefix:
First Name:MALLEY
Middle Name:ELIZABETH
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2756
Mailing Address - Country:US
Mailing Address - Phone:507-301-3412
Mailing Address - Fax:507-301-3308
Practice Address - Street 1:570 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2756
Practice Address - Country:US
Practice Address - Phone:507-301-3412
Practice Address - Fax:507-301-3308
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2056101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2056OtherLPCC