Healthcare Provider Details

I. General information

NPI: 1285890053
Provider Name (Legal Business Name): CHRISTIAN PAUL MORTENSON MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4045 LAKE OTIS PKWY SUITE 101
ANCHORAGE AK
99508-5227
US

IV. Provider business mailing address

4045 LAKE OTIS PKWY SUITE 101
ANCHORAGE AK
99508-5227
US

V. Phone/Fax

Practice location:
  • Phone: 907-561-0954
  • Fax: 907-561-7093
Mailing address:
  • Phone: 907-561-0954
  • Fax: 907-561-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: