Provider Demographics
NPI:1639107386
Name:DONAHUE, CHRISTOPHER (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:DONAHUE
Suffix:
Gender:M
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 S 6TH ST STE F256
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1336
Mailing Address - Country:US
Mailing Address - Phone:612-273-9800
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST STE F256
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4589103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1044585OtherPREFERRED ONE
MN2378189OtherARAZ
IA0716076Medicaid
MN503K3DOOtherBCBS
MT0492966Medicaid
MNHP55119OtherHEALTHPARTNERS
MN136425OtherUCARE