1386778082 NPI number — MRS. TAMMY RAY CHRISTENSEN EDS LPC NCC

Table of content: MRS. TAMMY RAY CHRISTENSEN EDS LPC NCC (NPI 1386778082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386778082 NPI number — MRS. TAMMY RAY CHRISTENSEN EDS LPC NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHRISTENSEN
Provider First Name:
TAMMY
Provider Middle Name:
RAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
EDS LPC NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386778082
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
413 S MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JASPER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-394-2777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S PREWITT
Provider Second Line Business Practice Location Address:
ALLIED MENTAL HEALTH ASSOCIATES
Provider Business Practice Location Address City Name:
NEVADA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-667-8700
Provider Business Practice Location Address Fax Number:
417-667-7382
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  2006022863 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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