Provider Demographics
NPI:1659635795
Name:CHRISTIANSON, TAMARA K (LPC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:K
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:K
Other - Last Name:MARTINEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:201 S BARSTOW ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3602
Mailing Address - Country:US
Mailing Address - Phone:715-832-2221
Mailing Address - Fax:715-838-8423
Practice Address - Street 1:2004 HIGHLAND AVE STE M
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4389
Practice Address - Country:US
Practice Address - Phone:715-835-5915
Practice Address - Fax:715-835-8112
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3945-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional