Provider Demographics
NPI:1942703947
Name:CHRISTENSEN, TIMOTHY BLAIR (CMHC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BLAIR
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 S FOREST SPRING WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2240
Mailing Address - Country:US
Mailing Address - Phone:801-706-3022
Mailing Address - Fax:
Practice Address - Street 1:4465 S 900 E STE 150
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-3944
Practice Address - Country:US
Practice Address - Phone:435-248-2089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9415842-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health