MEDICARE: KIMBERLY CHRISTENSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	2021015220	MO
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083038905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY CHRISTENSON

Provider Business Mailing Address
First Line	:	1286 CALLEN ST
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95688-3002
Country	:	US
Telephone Number	:	707-447-8982
Fax Number	:	707-447-3205

Provider Business Practice Location Address
First Line	:	1721 W ELFINDALE ST STE B
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65807-1295
Country	:	US
Telephone Number	:	417-874-1942
Fax Number	:	707-447-3205

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/10/2023

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Directions to “ KIMBERLY CHRISTENSON ” Practice Location

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