Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 3100160-2501 | UT |
Y | 103TC0700X | Clinical Psychologist | 3100160-2501 | UT |
N | 103G00000X | Clinical Psychologist | 3100160-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 3100160-2501 | UT |
N | 103TF0200X | Forensic Psychologist | 3100160-2501 | UT |
N | 103TH0004X | Health Psychologist | 3100160-2501 | UT |
N | 103TR0400X | Rehabilitation Psychologist | 3100160-2501 | UT |
NPI | 1457632820 |
---|---|
Provider Name | Dr. Benjamin David Christiansen |
First Address | Layton, UT 84041-0337 |
Second Address | Layton, UT 84041-5656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2011 |
Last Update Date | 21/10/2021 |