Basic Information
Provider Information
NPI: 1003003948
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CHRISTENSEN
FirstName: DANIEL
MiddleName: ANTHONY
NamePrefix: DR.
NameSuffix:  
Credential: PSY.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 SIBLEY ST
Address2: SUITE 500
City: SAINT PAUL
State: MN
PostalCode: 551011941
CountryCode: US
TelephoneNumber: 6512561979
FaxNumber:  
Practice Location
Address1: 190 5TH ST E
Address2: SUITE 100
City: SAINT PAUL
State: MN
PostalCode: 551012666
CountryCode: US
TelephoneNumber: 6512911979
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/25/2007
LastUpdateDate: 09/25/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103TC0700XLP4839MNY Behavioral Health & Social Service ProvidersPsychologistClinical

No ID Information.


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