Provider Demographics
NPI:1396867826
Name:CHRISTIANSON, CHERYL (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-4841
Mailing Address - Country:US
Mailing Address - Phone:208-321-0634
Mailing Address - Fax:208-321-1082
Practice Address - Street 1:1007 W ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-1878
Practice Address - Country:US
Practice Address - Phone:208-461-2838
Practice Address - Fax:208-461-5099
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health