Provider Demographics
NPI:1184809311
Name:CHRISTENSEN, SHERRY JEAN (CPCI)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:JEAN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:UT
Mailing Address - Zip Code:84647-1331
Mailing Address - Country:US
Mailing Address - Phone:435-462-2416
Mailing Address - Fax:435-462-3950
Practice Address - Street 1:656 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEPHI
Practice Address - State:UT
Practice Address - Zip Code:84648-1123
Practice Address - Country:US
Practice Address - Phone:435-623-1456
Practice Address - Fax:435-623-1127
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4922196-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4922196-6009OtherUTAH STATE LICENSE