Healthcare Provider Details

I. General information

NPI: 1265667489
Provider Name (Legal Business Name): CHRISTINE D ADDISON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 NE 69TH PL STE 41
ANKENY IA
50021-8905
US

IV. Provider business mailing address

600 PARK AVE
DES MOINES IA
50315-7639
US

V. Phone/Fax

Practice location:
  • Phone: 307-254-4450
  • Fax:
Mailing address:
  • Phone: 307-271-7306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT-073921
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: