Provider Demographics
NPI:1144271685
Name:CHRISTOPHERSEN, EDWARD R (PHD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:R
Last Name:CHRISTOPHERSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:9853 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3229
Mailing Address - Country:US
Mailing Address - Phone:913-383-3936
Mailing Address - Fax:913-383-2498
Practice Address - Street 1:5520 COLLEGE BLVD
Practice Address - Street 2:CHILDREN'S MERCY SPECIALTY CENTER, S. 130
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66211
Practice Address - Country:US
Practice Address - Phone:913-696-8261
Practice Address - Fax:913-696-8395
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR0145103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical