MEDICARE: JACQUELYN CHRISTENSEN

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	78223	CA

General Provider Information

NPI Number	:	1285008086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN CHRISTENSEN

Provider Business Mailing Address
First Line	:	PO BOX 1291
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92628-1291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S BEACH BLVD
Second Line	:	STE 1
City	:	LA HABRA
State	:	CA
Zip	:	90631-5164
Country	:	US
Telephone Number	:	763-607-0300
Fax Number	:

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

Provider Enumeration Date	:	11/17/2015
Last Update Date	:	11/17/2015

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Directions to “ JACQUELYN CHRISTENSEN ” Practice Location

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