Provider Demographics
NPI:1639224207
Name:JORGENSEN, CHRISTINE ELLEN (MA, LMFT, CMHS)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ELLEN
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:MA, LMFT, CMHS
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELLEN
Other - Last Name:PUEBLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT, CMHS
Mailing Address - Street 1:5301 TIETON DR STE C
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3479
Mailing Address - Country:US
Mailing Address - Phone:509-965-7100
Mailing Address - Fax:
Practice Address - Street 1:5301 TIETON DR STE C
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3479
Practice Address - Country:US
Practice Address - Phone:509-965-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00053850101YM0800X
WALF60300097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health