Provider Demographics
NPI:1699752733
Name:SUSAN CHRISTENSEN, LCSW, PC
Entity type:Organization
Organization Name:SUSAN CHRISTENSEN, LCSW, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:SNOW
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, RPT-S
Authorized Official - Phone:801-426-8862
Mailing Address - Street 1:PO BOX 2185
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84059-2185
Mailing Address - Country:US
Mailing Address - Phone:801-426-8862
Mailing Address - Fax:801-225-7310
Practice Address - Street 1:448 W 300 S
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-5395
Practice Address - Country:US
Practice Address - Phone:801-426-8862
Practice Address - Fax:801-225-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT129634-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty