Provider Demographics
NPI:1912211020
Name:CHRISTENSEN, AMY M (LCPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LCPC, NCC
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 4326
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4326
Mailing Address - Country:US
Mailing Address - Phone:208-220-4581
Mailing Address - Fax:
Practice Address - Street 1:454 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-3845
Practice Address - Country:US
Practice Address - Phone:208-244-9002
Practice Address - Fax:208-427-9331
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-30
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK217799101YM0800X
WALH61512932101YM0800X
ORC836681101YM0800X
ID5577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health