Provider Demographics
NPI:1548620941
Name:PENA, CHRISTINE I (LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:I
Last Name:PENA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7808 NOID DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2206
Mailing Address - Country:US
Mailing Address - Phone:763-445-9801
Mailing Address - Fax:
Practice Address - Street 1:10650 COUNTY ROAD 81 STE 133
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4020
Practice Address - Country:US
Practice Address - Phone:763-445-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-26
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist