Healthcare Provider Details

I. General information

NPI: 1144778176
Provider Name (Legal Business Name): DR. ADAM KRISTEVSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14441 W MCDOWELL RD STE B102
GOODYEAR AZ
85395-2519
US

IV. Provider business mailing address

14441 W MCDOWELL RD STE B102
GOODYEAR AZ
85395-2519
US

V. Phone/Fax

Practice location:
  • Phone: 480-516-8037
  • Fax: 480-210-7543
Mailing address:
  • Phone: 480-516-8037
  • Fax: 480-210-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4773
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: