Healthcare Provider Details

I. General information

NPI: 1003828278
Provider Name (Legal Business Name): CHRISTINE CATHERINE ZYCH PSYD, LP, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE CATHERINE ZYCH-OELLIEN LMFT

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W MAIN ST STE 1
MARSHALL MN
56258-3783
US

IV. Provider business mailing address

430 W MAIN ST STE 1
MARSHALL MN
56258-3783
US

V. Phone/Fax

Practice location:
  • Phone: 507-476-5462
  • Fax: 507-401-3021
Mailing address:
  • Phone: 507-476-5462
  • Fax: 507-401-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberLP5962
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1049
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: