Healthcare Provider Details

I. General information

NPI: 1114100864
Provider Name (Legal Business Name): CHRISTENA MARIE HERMANSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1875 STATION PKWY NW
ANDOVER MN
55304-4259
US

IV. Provider business mailing address

1875 STATION PKWY NW
ANDOVER MN
55304-3319
US

V. Phone/Fax

Practice location:
  • Phone: 612-865-1169
  • Fax:
Mailing address:
  • Phone: 612-865-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1606
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: