Provider Demographics
NPI:1740826932
Name:CHRISTIANSEN, JODY GILLESPIE (LPC)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:GILLESPIE
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 1:5631 N 75TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6471
Mailing Address - Country:US
Mailing Address - Phone:480-220-5856
Mailing Address - Fax:
Practice Address - Street 1:5631 N 75TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-6471
Practice Address - Country:US
Practice Address - Phone:480-220-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional