Provider Demographics
NPI:1629101563
Name:JOHANNSEN-ELBLING, CHRISTINA M
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:JOHANNSEN-ELBLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:JOHANNSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15750 HILLGATE DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1516
Mailing Address - Country:US
Mailing Address - Phone:562-902-3849
Mailing Address - Fax:
Practice Address - Street 1:9140 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2444
Practice Address - Country:US
Practice Address - Phone:562-801-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health