Provider Demographics
NPI:1477586600
Name:CHRISTIANSEN, KIMBERLY JANE (LPC, MA, CADC III)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JANE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:LPC, MA, CADC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 SE BELMONT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:971-678-7581
Mailing Address - Fax:503-841-5816
Practice Address - Street 1:4531 SE BELMONT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:971-678-7581
Practice Address - Fax:503-841-5816
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC2047101YP2500X
OR08-06-97101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)