Provider Demographics
NPI:1326454471
Name:CHRISTOPHERSON, CODY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CODY
Middle Name:
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SISKIYOU BLVD
Mailing Address - Street 2:PSYCHOLOGY DEPARTMENT
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-5001
Mailing Address - Country:US
Mailing Address - Phone:541-552-8491
Mailing Address - Fax:541-552-6988
Practice Address - Street 1:1250 SISKIYOU BLVD
Practice Address - Street 2:PSYCHOLOGY DEPARTMENT
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-5001
Practice Address - Country:US
Practice Address - Phone:541-552-8491
Practice Address - Fax:541-552-6988
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2443103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist