Healthcare Provider Details

I. General information

NPI: 1598308835
Provider Name (Legal Business Name): CHRISTINA KELLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2019
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4539 N 22ND ST # 4222
PHOENIX AZ
85016-4639
US

IV. Provider business mailing address

4539 N 22ND ST # 4222
PHOENIX AZ
85016-4639
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-9568
  • Fax:
Mailing address:
  • Phone: 623-624-9568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-10924
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0022517
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: