Provider Demographics
NPI:1639136088
Name:CHRISTIANSEN, MATTHEW D (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 COURT MERRILL
Mailing Address - Street 2:ABBOTT HOUSE, INC.
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-4362
Mailing Address - Country:US
Mailing Address - Phone:605-996-2486
Mailing Address - Fax:605-996-4585
Practice Address - Street 1:910 W HAVENS STREET
Practice Address - Street 2:DAKOTA COUNSELING INSTITUTE
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301
Practice Address - Country:US
Practice Address - Phone:605-996-9689
Practice Address - Fax:605-996-1624
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SD488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD33171OtherSIOUX VALLEY HEALTH
SD9189OtherAVERA HEALTH
SD91400318Medicaid
SDSD449OtherDAKOTACARE
SD4995782OtherWELLMARK BC BS
SDSD449OtherDAKOTACARE