Provider Demographics
NPI:1568883635
Name:BASTIAN, CHRISTINA (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BASTIAN
Suffix:
Gender:F
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E 300 N UNIT 112
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-2670
Mailing Address - Country:US
Mailing Address - Phone:801-995-1789
Mailing Address - Fax:
Practice Address - Street 1:534 E 300 N UNIT 112
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-2670
Practice Address - Country:US
Practice Address - Phone:801-995-1789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health