Provider Demographics
NPI:1629692892
Name:CHRISTENSEN, MADISON CLAIRE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:CLAIRE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BROADWAY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3425
Mailing Address - Country:US
Mailing Address - Phone:505-242-6988
Mailing Address - Fax:505-242-6972
Practice Address - Street 1:218 BROADWAY BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3425
Practice Address - Country:US
Practice Address - Phone:505-242-6988
Practice Address - Fax:505-242-6972
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2023-0579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist