Provider Demographics
NPI:1891103578
Name:CHRISTENSON, CARL JAMES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:JAMES
Last Name:CHRISTENSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 KENYON ST BLDG B2
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5001
Mailing Address - Country:US
Mailing Address - Phone:877-496-0450
Mailing Address - Fax:619-221-6565
Practice Address - Street 1:8910 CLAIREMONT MESA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1104
Practice Address - Country:US
Practice Address - Phone:858-514-5163
Practice Address - Fax:858-514-5194
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96715106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist