Healthcare Provider Details

I. General information

NPI: 1285706101
Provider Name (Legal Business Name): JAMES M CHRISTIANSON BA, CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 1ST AVE E STE 200
NEWTON IA
50208
US

IV. Provider business mailing address

1123 1ST AVE E STE 200
NEWTON IA
50208
US

V. Phone/Fax

Practice location:
  • Phone: 641-792-4012
  • Fax: 641-791-0697
Mailing address:
  • Phone: 641-792-4012
  • Fax: 641-791-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number06138
License Number StateIA

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: