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General NPI Number Information
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NPI Number | 1790088656
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Entity Type | Individual
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Provider Name | JASON WAYNE CHRISTOPHERSON PSYD, ABPP
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Gender | Male
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 1781 E FIR AVE STE 101
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City | FRESNO
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State | CA
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Zip | 93720-3865
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Country | US
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Telephone | 559-387-4575
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Fax |
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Provider Business Mailing Address
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Address Line | 2167 SHAW AVE, SUITE 115 #212
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City | CLOVIS
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State | CA
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Zip | 93611-8935
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Country | US
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Telephone | 559-387-4575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 10984796-2501
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0947
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY26684
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License Number State | CA
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