Organization
JOHN L CHRISTENSEN PHD PC
Active
Parent organization
JOHN L CHRISTENSEN PHD PC
Other names
Psychosocial Rehabilitation Specialists
Organization subpart
Yes
Provider details
NPI number
Legal business name
JOHN L CHRISTENSEN PHD PC
Authorized official
NICHOLE CHRISTENSEN (SECRETARY)
(208) 234-1707
Entity
Organization
Contact information
Practice address
500 S 11TH AVE, SUITE 302, POCATELLO, ID 83201
(208) 233-0150
(208) 233-0159
Mailing address
13235 N MANNING LN, POCATELLO, ID 83202-5184
(208) 233-0150
(208) 233-0159
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
PSY202148
ID
251S00000X
Community/Behavioral Health Agency
PSY202148
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807691400
—
ID
Enumeration date
04/10/2007
Last updated
05/27/2009
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