Provider Demographics
NPI:1780071365
Name:MALTERS, CHRISTINA ELENI (PA-C, CMHC, LASUDC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:ELENI
Last Name:MALTERS
Suffix:
Gender:F
Credentials:PA-C, CMHC, LASUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 N 8000 W
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-3961
Mailing Address - Country:US
Mailing Address - Phone:801-522-7000
Mailing Address - Fax:
Practice Address - Street 1:1480 N 8000 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3961
Practice Address - Country:US
Practice Address - Phone:801-522-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9166634-6008101YA0400X
UT9166634-6004101YM0800X
UT9166634-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health