Healthcare Provider Details

I. General information

NPI: 1013622612
Provider Name (Legal Business Name): SCOTT C CHRISTENSEN SUDP-T
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD BLDG 17
VANCOUVER WA
98661-3717
US

IV. Provider business mailing address

PO BOX 1678
VANCOUVER WA
98668-1678
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCO61569031
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: