Provider Demographics
NPI:1851407936
Name:CHRISTIANSEN, BEVERLY BLAINE (LMFT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:BLAINE
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:TAYLOR
Other - Last Name:THAGGARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 JUDSON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4708
Mailing Address - Country:US
Mailing Address - Phone:903-242-9555
Mailing Address - Fax:903-242-9555
Practice Address - Street 1:1800 JUDSON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4708
Practice Address - Country:US
Practice Address - Phone:903-242-9555
Practice Address - Fax:903-242-9555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11323101YP2500X
TX2745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3999LCOtherBLUE CROSS BLUE SHIELD