Healthcare Provider Details

I. General information

NPI: 1366162505
Provider Name (Legal Business Name): KRISTA JEAN PERDUE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 E CAMELBACK RD STE 285
PHOENIX AZ
85016-4769
US

IV. Provider business mailing address

8540 E MCDOWELL RD UNIT 119
MESA AZ
85207-1433
US

V. Phone/Fax

Practice location:
  • Phone: 602-292-0641
  • Fax:
Mailing address:
  • Phone: 314-330-3292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY-005840
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: