Basic Information
| Provider Information | |||||||||
| NPI: | 1639107386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DONAHUE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD, LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2312 S 6TH ST STE F256 | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122739800 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2312 S 6TH ST STE F256 | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6122738700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | LP4589 | MN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 1044585 | 01 | MN | PREFERRED ONE | OTHER | 2378189 | 01 | MN | ARAZ | OTHER | 0716076 | 05 | IA | MEDICAID | 503K3DO | 01 | MN | BCBS | OTHER | 0492966 | 05 | MT | MEDICAID | HP55119 | 01 | MN | HEALTHPARTNERS | OTHER | 136425 | 01 | MN | UCARE | OTHER |