Provider Demographics
NPI:1265744353
Name:CHRISTIANSEN, CARRIE S (LPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:S
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E MCDOWELL RD STE 107-123
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1549
Mailing Address - Country:US
Mailing Address - Phone:602-429-9794
Mailing Address - Fax:
Practice Address - Street 1:1122 W CULVER ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1909
Practice Address - Country:US
Practice Address - Phone:602-429-9794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16462101YP2500X, 101YP2500X
MO2010018846101YP2500X
KS2151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232061Medicaid