Healthcare Provider Details

I. General information

NPI: 1336606805
Provider Name (Legal Business Name): CHRISTINA MCSHANE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 E PALM LN
PHOENIX AZ
85004-1532
US

IV. Provider business mailing address

389 E PALM LN STE 1
PHOENIX AZ
85004-1532
US

V. Phone/Fax

Practice location:
  • Phone: 602-688-9524
  • Fax:
Mailing address:
  • Phone: 602-688-9524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY-004932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: