Healthcare Provider Details

I. General information

NPI: 1871413617
Provider Name (Legal Business Name): CHRISTOPHER DEVON JOSEPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E MISSOURI AVE
PHOENIX AZ
85014-2708
US

IV. Provider business mailing address

5225 W BRANHAM LN
LAVEEN AZ
85339-7108
US

V. Phone/Fax

Practice location:
  • Phone: 602-932-3436
  • Fax:
Mailing address:
  • Phone: 480-823-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMSW-08460T
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: