Provider Demographics
NPI:1376029843
Name:CHRISTOPHERSON, JESSIE LEANN (LMHC)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:LEANN
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1917
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51102-1917
Mailing Address - Country:US
Mailing Address - Phone:712-252-3871
Mailing Address - Fax:
Practice Address - Street 1:625 COURT ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1919
Practice Address - Country:US
Practice Address - Phone:712-252-3871
Practice Address - Fax:712-252-3157
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health