Healthcare Provider Details

I. General information

NPI: 1770291718
Provider Name (Legal Business Name): KRISTOPHER TUTTLE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 E MCDOWELL RD
PHOENIX AZ
85008-4227
US

IV. Provider business mailing address

4909 E MCDOWELL RD
PHOENIX AZ
85008-4227
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-6000
  • Fax: 602-275-1355
Mailing address:
  • Phone: 602-685-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-23789
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: