Healthcare Provider Details
I. General information
NPI: 1063506731
Provider Name (Legal Business Name): JEFFREY NED CHRISTENSEN MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/03/2006
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2411 MARTIN LUTHER KING JR BLVD
EUGENE OR
97401-5824
US
IV. Provider business mailing address
413 KINGSBURY AVE
EUGENE OR
97404-1072
US
V. Phone/Fax
- Phone: 541-682-3608
- Fax:
- Phone: 541-654-2513
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 101YP2500X |
| Taxonomy | Professional Counselor |
| License Number | 0701003638 |
| License Number State | VA |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 146171 |
| Identifier Type | OTHER |
| Identifier State | VA |
| Identifier Issuer | ANTHEM PRIVATE PRAC. |
| # 2 | |
| Identifier | 004945263 |
| Identifier Type | MEDICAID |
| Identifier State | VA |
| Identifier Issuer | |
| # 3 | |
| Identifier | 010114128 |
| Identifier Type | MEDICAID |
| Identifier State | VA |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: