Provider Demographics
NPI:1255153672
Name:CHRISTIANSON, PAMELA A
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:CHRISTIANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7997 E SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-4030
Mailing Address - Country:US
Mailing Address - Phone:480-599-7199
Mailing Address - Fax:
Practice Address - Street 1:300 W CLARENDON AVE STE 470
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3475
Practice Address - Country:US
Practice Address - Phone:602-354-8906
Practice Address - Fax:602-391-2522
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21719101YM0800X
AZLPC-23837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health