MEDICARE: NEAL CHRISTENSEN PHD

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	103TC1900X	Counseling Psychologist	6242392-2501	UT

General Provider Information

NPI Number	:	1649674318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEAL CHRISTENSEN PHD

Provider Business Mailing Address
First Line	:	3713 S TWINBROOK ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3713
Country	:	US
Telephone Number	:	801-310-3381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3713 S TWINBROOK ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-3713
Country	:	US
Telephone Number	:	801-310-3381
Fax Number	:

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

Provider Enumeration Date	:	10/09/2014
Last Update Date	:	10/09/2014

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