Individual
MATTHEW R CHRISTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
5230 W MOONLIGHT MINE RD., POCATELLO, ID 83201-8320
(208) 351-3956
Mailing address
PO BOX 4908, POCATELLO, ID 83205-4908
(208) 236-1600
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCSW-36921
ID
104100000X
Social Worker
LMSW-32118
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-36921
ID
Other
Enumeration date
05/03/2012
Last updated
05/09/2022
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