Provider Demographics
NPI:1932523586
Name:CHRISTENSEN, TAMMY (LED,LSP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LED,LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 DUGGINS
Mailing Address - Street 2:
Mailing Address - City:MAGDALENA
Mailing Address - State:NM
Mailing Address - Zip Code:87825
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 DUGGINS
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825
Practice Address - Country:US
Practice Address - Phone:602-540-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM346037103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM99472279Medicaid