Provider Demographics
NPI:1396521795
Name:CHRISTENSEN, KATIE (WY PPC 1407)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:WY PPC 1407
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 N 4TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2066
Mailing Address - Country:US
Mailing Address - Phone:307-760-5929
Mailing Address - Fax:
Practice Address - Street 1:1465 N 4TH ST STE 113
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2066
Practice Address - Country:US
Practice Address - Phone:307-399-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1407101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health