Provider Demographics
NPI:1184780983
Name:CHAMPOUX, CHRISTIE M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIE
Middle Name:M
Last Name:CHAMPOUX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 E NANCY CT
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9437
Mailing Address - Country:US
Mailing Address - Phone:509-468-9627
Mailing Address - Fax:
Practice Address - Street 1:10103 N DIVISION ST STE 203
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1381
Practice Address - Country:US
Practice Address - Phone:509-995-0780
Practice Address - Fax:509-465-1152
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000045961041C0700X, 104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor