Provider Demographics
NPI:1992085948
Name:MAKI, CHRISTINA CAY JOHNSON (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:CAY JOHNSON
Last Name:MAKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2551 COORS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-1213
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2503 RIDGE RUNNER RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4972
Practice Address - Country:US
Practice Address - Phone:505-454-8265
Practice Address - Fax:505-454-8268
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0163151106H00000X
KST-LMFT 1242106H00000X
NM0172961106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0172961OtherSTATE OF NEW MEXICO LICENSING BOARD
NM76136345Medicaid