Provider Demographics
NPI:1922460435
Name:CHRISTY, DAVID M (LMFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:CHRISTY
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 1:7180 SW FIR LOOP STE 1A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8077
Mailing Address - Country:US
Mailing Address - Phone:503-639-3009
Mailing Address - Fax:503-620-3453
Practice Address - Street 1:7180 SW FIR LOOP STE 1A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8077
Practice Address - Country:US
Practice Address - Phone:503-639-3009
Practice Address - Fax:503-620-3453
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist