Healthcare Provider Details

I. General information

NPI: 1609282268
Provider Name (Legal Business Name): CHRISTOPHER JOHANN MARGESON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 N KENDRICK ST STE 4
FLAGSTAFF AZ
86001-1582
US

IV. Provider business mailing address

408 N KENDRICK ST STE 4
FLAGSTAFF AZ
86001-1582
US

V. Phone/Fax

Practice location:
  • Phone: 928-774-6364
  • Fax: 928-556-0504
Mailing address:
  • Phone: 928-774-6364
  • Fax: 928-556-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4521
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: