Provider Demographics
NPI:1598813776
Name:ROBERTSON, CHRISTOPHER ALAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 FASHION BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-6159
Mailing Address - Country:US
Mailing Address - Phone:801-596-0147
Mailing Address - Fax:801-716-4049
Practice Address - Street 1:5801 FASHION BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-6159
Practice Address - Country:US
Practice Address - Phone:801-596-0147
Practice Address - Fax:801-716-4049
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139307-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000007135Medicare ID - Type Unspecified