Healthcare Provider Details

I. General information

NPI: 1336806199
Provider Name (Legal Business Name): ANDREA KHALIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 E SOUTHERN AVE STE 6
TEMPE AZ
85282-7628
US

IV. Provider business mailing address

16465 E ASHBROOK DR UNIT B
FOUNTAIN HILLS AZ
85268-2008
US

V. Phone/Fax

Practice location:
  • Phone: 602-845-9226
  • Fax:
Mailing address:
  • Phone: 602-845-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21882
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-19183
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: