Provider Demographics
NPI:1760784680
Name:CHRISTENSEN, CHEYENNE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:CHRISTENSEN
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 1:545 E. 300 S. APT B
Mailing Address - Street 2:
Mailing Address - City:ST. GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770
Mailing Address - Country:US
Mailing Address - Phone:801-372-8797
Mailing Address - Fax:
Practice Address - Street 1:SOUTHWEST BEHAVIORAL HEALTH 474 W 200 N
Practice Address - Street 2:#200
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3748
Practice Address - Country:US
Practice Address - Phone:435-634-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174868007101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health