Provider Demographics
NPI:1790088656
Name:CHRISTOPHERSON, JASON WAYNE (PSYD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:WAYNE
Last Name:CHRISTOPHERSON
Suffix:
Gender:M
Credentials:PSYD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2167 SHAW AVE, SUITE 115 #212
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8935
Mailing Address - Country:US
Mailing Address - Phone:559-387-4575
Mailing Address - Fax:
Practice Address - Street 1:1781 E FIR AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3865
Practice Address - Country:US
Practice Address - Phone:559-387-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10984796-2501103TC0700X
NVPY0947103TC0700X
CAPSY26684103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical