Provider Demographics
NPI:1629785316
Name:MAIER, CHRISTINE LYNN
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LYNN
Last Name:MAIER
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 1:12567 W CEDAR DR STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2009
Mailing Address - Country:US
Mailing Address - Phone:719-980-1920
Mailing Address - Fax:
Practice Address - Street 1:12567 W CEDAR DR STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2009
Practice Address - Country:US
Practice Address - Phone:719-980-1920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9000175095101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84-0500375Medicaid