Provider Demographics
NPI:1891738894
Name:CHRISTIANSEN, MARTHA D (PHD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:D
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5199
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5199
Mailing Address - Country:US
Mailing Address - Phone:325-437-8300
Mailing Address - Fax:325-437-8399
Practice Address - Street 1:1150 S FOREST
Practice Address - Street 2:#334
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85287
Practice Address - Country:US
Practice Address - Phone:480-965-6147
Practice Address - Fax:480-965-3426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3455103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical