Provider Demographics
NPI:1881667731
Name:SECRIST, CHRISTINE ANN (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANN
Last Name:SECRIST
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4713 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8632
Mailing Address - Country:US
Mailing Address - Phone:515-229-9587
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:IA
Practice Address - Zip Code:50220-1803
Practice Address - Country:US
Practice Address - Phone:515-465-5739
Practice Address - Fax:515-465-5744
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA18699OtherMIDLANDS CHOICE
IA18699OtherMIDLANDS CHOICE