Healthcare Provider Details

I. General information

NPI: 1487314803
Provider Name (Legal Business Name): CHRISTINE SLOMSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S DOBSON RD STE 213
MESA AZ
85202-5663
US

IV. Provider business mailing address

2422 E LYNWOOD CIR
MESA AZ
85213-2374
US

V. Phone/Fax

Practice location:
  • Phone: 928-900-4113
  • Fax:
Mailing address:
  • Phone: 720-550-1556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-6969T
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-6969T
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLAC-6969T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: