Provider Demographics
NPI:1871968602
Name:CHRISTOPHERSEN, JEFFREY A (CADC1, QMHA1)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:A
Last Name:CHRISTOPHERSEN
Suffix:
Gender:M
Credentials:CADC1, QMHA1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SW G ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-2544
Mailing Address - Country:US
Mailing Address - Phone:541-476-2373
Mailing Address - Fax:541-471-2679
Practice Address - Street 1:109 NW MANZANITA AVE
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526
Practice Address - Country:US
Practice Address - Phone:541-479-8847
Practice Address - Fax:541-471-2679
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16-04-28101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)