Provider Demographics
NPI:1639136088
Name:CHRISTIANSEN, MATTHEW D (PHD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7303
Mailing Address - Country:US
Mailing Address - Phone:605-299-2829
Mailing Address - Fax:
Practice Address - Street 1:115 E HAVENS AVE STE 102
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-4462
Practice Address - Country:US
Practice Address - Phone:605-299-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDSD449OtherDAKOTACARE
SD33171OtherSIOUX VALLEY HEALTH
SD91400318Medicaid
SD9189OtherAVERA HEALTH
SD4995782OtherWELLMARK BC BS
SDSD449OtherDAKOTACARE