Provider Demographics
NPI:1942416532
Name:CHRISTOPHERSON, JOSEPH BRADLEY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRADLEY
Last Name:CHRISTOPHERSON
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 1:4812 W SYLVESTER ST
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2449
Mailing Address - Country:US
Mailing Address - Phone:509-205-9124
Mailing Address - Fax:
Practice Address - Street 1:600 SHOCKLEY RD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-6704
Practice Address - Country:US
Practice Address - Phone:509-628-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00002424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist