Healthcare Provider Details

I. General information

NPI: 1003987215
Provider Name (Legal Business Name): CHRISTINE CHAPMAN PAULSON LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 MAYWOOD RD STE 202
MOUND MN
55364-1776
US

IV. Provider business mailing address

2552 COLFAX AVE S
MINNEAPOLIS MN
55405-2946
US

V. Phone/Fax

Practice location:
  • Phone: 952-472-2408
  • Fax: 952-495-1409
Mailing address:
  • Phone: 612-203-8433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1213
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: