Provider Demographics
NPI:1962858175
Name:CHRISTIANSEN, KURT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 WILSHIRE BLVD # 843
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:818-206-9470
Mailing Address - Fax:
Practice Address - Street 1:19634 VENTURA BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2966
Practice Address - Country:US
Practice Address - Phone:818-206-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27921103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical