Provider Demographics
NPI:1134348949
Name:CHRISTENSON, TAMARA B (LICSW)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:B
Last Name:CHRISTENSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5476 MUD LAKE LN SW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-6304
Mailing Address - Country:US
Mailing Address - Phone:320-763-9612
Mailing Address - Fax:320-762-0796
Practice Address - Street 1:324 BROADWAY ST STE 206
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1482
Practice Address - Country:US
Practice Address - Phone:320-762-1762
Practice Address - Fax:320-762-0796
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN138971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN524G3CHOtherBCBSMN
MN31002005OtherPRIME WEST
MN652620900Medicaid
MN56308-A003OtherTRIWEST
MN138661OtherUCARE
MN990991049165OtherBHP PREFERRED 1