Provider Demographics
NPI:1437661956
Name:CHRISTENSEN, MCKENZIE DAWN (LCPC)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:DAWN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MCKENZIE
Other - Middle Name:DAWN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:4833 WILTSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5353
Mailing Address - Country:US
Mailing Address - Phone:208-681-5270
Mailing Address - Fax:
Practice Address - Street 1:1219 YELLOWSTONE AVE STE D
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4368
Practice Address - Country:US
Practice Address - Phone:208-339-0909
Practice Address - Fax:208-241-2177
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6623101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional