Provider Demographics
NPI:1649283003
Name:CHRISTOFFERSEN, JULIA KAY (PHD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:KAY
Last Name:CHRISTOFFERSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:CHRISTOFFERSEN
Other - Last Name:STINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3764 HOLLAND CIR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5377
Mailing Address - Country:US
Mailing Address - Phone:435-272-2861
Mailing Address - Fax:465-275-2887
Practice Address - Street 1:437 S BLUFF ST STE 202
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3555
Practice Address - Country:US
Practice Address - Phone:435-272-2861
Practice Address - Fax:465-275-2887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE239103T00000X
UT7752010-2501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47077371426Medicaid
NE262549Medicare ID - Type UnspecifiedPSYCHOLOGY