Healthcare Provider Details

I. General information

NPI: 1861304313
Provider Name (Legal Business Name): KRISTOPHER L SHEETS LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3062 S JACOB ST
GILBERT AZ
85295-1660
US

IV. Provider business mailing address

3062 S JACOB ST
GILBERT AZ
85295-1660
US

V. Phone/Fax

Practice location:
  • Phone: 480-459-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-22546
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: