Provider Demographics
NPI:1689824963
Name:CHRISTENSEN, MARY CANDACE (CSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:CANDACE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2342
Mailing Address - Country:US
Mailing Address - Phone:801-971-7866
Mailing Address - Fax:
Practice Address - Street 1:3703 WEST 6200 SOUTH
Practice Address - Street 2:VALLEY MENTAL HEALTH ARTEC - THERAPEUTIC FOSTER CARE
Practice Address - City:BENNION
Practice Address - State:UT
Practice Address - Zip Code:84118
Practice Address - Country:US
Practice Address - Phone:801-955-9686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT706670335021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical