Provider Demographics
NPI:1629308820
Name:CHRISTENSEN, JEFF DANE (MA)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:DANE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:JEFF
Other - Middle Name:DANE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:5583 SUNSHINE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-9458
Mailing Address - Country:US
Mailing Address - Phone:541-672-4055
Mailing Address - Fax:
Practice Address - Street 1:5583 SUNSHINE RD
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-9458
Practice Address - Country:US
Practice Address - Phone:541-672-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1045101YP2500X
CA20868106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional