Provider Demographics
NPI:1194450841
Name:CHRISTENSEN, JOSHUA (AAS,SUDP, R-AAC, CPC)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:AAS,SUDP, R-AAC, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0059
Mailing Address - Country:US
Mailing Address - Phone:360-740-4380
Mailing Address - Fax:360-740-1877
Practice Address - Street 1:1956 NE KRESKY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-2307
Practice Address - Country:US
Practice Address - Phone:360-740-4380
Practice Address - Fax:360-740-1877
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61260470101Y00000X
WACG61436039175T00000X
WACP61550600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2212571Medicaid