Basic Information
| Provider Information | |||||||||
| NPI: | 1568674158 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHRISTENSEN | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | HERBERT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3215 S BILLINGSGATE CIR NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447081088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308343210 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3722 WHIPPLE AVE NW | ||||||||
| Address2: | BARBARA L FORDYCE & ASSOC | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304922006 | ||||||||
| FaxNumber: | 3304922161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 07/24/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 5959 | OH | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.