Healthcare Provider Details

I. General information

NPI: 1093673063
Provider Name (Legal Business Name): KARISSA LORRAINE VOSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARISSA LORRAINE BORDEN

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 N ARIZONA BLVD
COOLIDGE AZ
85128-3726
US

IV. Provider business mailing address

341 S 16TH ST
COOLIDGE AZ
85128-9275
US

V. Phone/Fax

Practice location:
  • Phone: 520-840-0697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-500839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: