Provider Demographics
NPI:1235450511
Name:EDDY, CHRISTINE LOUISE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:EDDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-6107
Mailing Address - Country:US
Mailing Address - Phone:541-882-7111
Mailing Address - Fax:541-882-7111
Practice Address - Street 1:325 S 5TH ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-6107
Practice Address - Country:US
Practice Address - Phone:541-882-7111
Practice Address - Fax:541-882-7111
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157144Medicare PIN