Healthcare Provider Details

I. General information

NPI: 1841002466
Provider Name (Legal Business Name): STEPHANIE CHRISTIANSON MC, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 E MISSOURI AVE STE 400
PHOENIX AZ
85014-2704
US

IV. Provider business mailing address

3432 E LINDA LN
GILBERT AZ
85234-4210
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-6554
  • Fax:
Mailing address:
  • Phone: 602-730-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-08362T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: