Provider Demographics
NPI:1750557716
Name:CHRISTIANSEN, JEFFREY ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:CHRISTIANSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5750
Mailing Address - Country:US
Mailing Address - Phone:740-349-7793
Mailing Address - Fax:740-349-7792
Practice Address - Street 1:172 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5750
Practice Address - Country:US
Practice Address - Phone:740-349-7793
Practice Address - Fax:740-349-7792
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical