Provider Demographics
NPI:1396059531
Name:CHRISTOPHERSON, KATHERINE ELAINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELAINE
Last Name:CHRISTOPHERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S THURMOND ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5059
Mailing Address - Country:US
Mailing Address - Phone:307-763-2830
Mailing Address - Fax:
Practice Address - Street 1:382 W STANLEY AVE
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85140-6669
Practice Address - Country:US
Practice Address - Phone:480-582-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
AZLPC-21534101YP2500X
WYLPC-1763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health