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NPI Code Detail

MEDICARE: MS. CANDICE CHRISTIANSEN LPC

MEDICARE:  MS. CANDICE  CHRISTIANSEN  LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor3609596004UT

General Provider Information

NPI Number : 1720211238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CANDICE CHRISTIANSEN LPC
Provider Business Mailing Address
First Line : 1790 KIERA CT
Second Line :
City : HOLLADAY
State : UT
Zip : 84124-3586
Country : US
Telephone Number : 480-274-5454
Fax Number :
Provider Business Practice Location Address
First Line : 4568 HIGHLAND DR STE 145
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84117-4242
Country : US
Telephone Number : 480-274-5454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2009
Last Update Date : 08/31/2009

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Directions to “ MS. CANDICE CHRISTIANSEN LPC” Practice Location

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