Provider Demographics
NPI:1336997584
Name:MATSON, CHRISTIANA (LMSW)
Entity type:Individual
Prefix:
First Name:CHRISTIANA
Middle Name:
Last Name:MATSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 JENSEN GROVE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1636
Mailing Address - Country:US
Mailing Address - Phone:208-274-4565
Mailing Address - Fax:
Practice Address - Street 1:725 JENSEN GROVE DR STE 4
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1636
Practice Address - Country:US
Practice Address - Phone:208-274-4565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-45108104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker