Provider Demographics
NPI:1467544197
Name:CHRISTENSEN, MARILYN JOY (LLP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JOY
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:REED
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLP
Mailing Address - Street 1:215 N KALAMAZOO AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1321
Mailing Address - Country:US
Mailing Address - Phone:269-655-6740
Mailing Address - Fax:269-655-2950
Practice Address - Street 1:215 N KALAMAZOO AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1321
Practice Address - Country:US
Practice Address - Phone:269-655-6740
Practice Address - Fax:269-655-2950
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007947103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
098509OtherVALUE OPTIONS