Healthcare Provider Details

I. General information

NPI: 1811601875
Provider Name (Legal Business Name): SRAE ANITA CHRISTENSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9122 N MURRAY RD
NEWMAN LAKE WA
99025-9454
US

IV. Provider business mailing address

9122 N MURRAY RD
NEWMAN LAKE WA
99025-9454
US

V. Phone/Fax

Practice location:
  • Phone: 509-999-9039
  • Fax:
Mailing address:
  • Phone: 509-999-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61092955
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: