Provider Demographics
NPI:1912211020
Name:CHRISTENSEN, AMY M (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 HAWTHORNE RD
Mailing Address - Street 2:SUITE #3B
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2376
Mailing Address - Country:US
Mailing Address - Phone:208-237-9833
Mailing Address - Fax:
Practice Address - Street 1:4650 HAWTHORNE RD
Practice Address - Street 2:SUITE #3B
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2376
Practice Address - Country:US
Practice Address - Phone:208-237-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID4592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health