MEDICARE: MRS. CRYSTAL PREMO CHRISTENSEN LCSW

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	1041C0700X	Clinical Social Worker	1086	CO

General Provider Information

NPI Number	:	1538369020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRYSTAL PREMO CHRISTENSEN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 863
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80402-0863
Country	:	US
Telephone Number	:	303-596-4023
Fax Number	:

Provider Business Practice Location Address
First Line	:	7878 WADSWORTH BLVD STE 100
Second Line	:
City	:	ARVADA
State	:	CO
Zip	:	80003-2121
Country	:	US
Telephone Number	:	303-596-4023
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	08/13/2010

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