Healthcare Provider Details

I. General information

NPI: 1437506714
Provider Name (Legal Business Name): MS. DARRIAN MARISA MCKIERNAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 09/18/2023
Certification Date: 09/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23804 S 231ST WAY
QUEEN CREEK AZ
85142-1548
US

IV. Provider business mailing address

23804 S 231ST WAY
QUEEN CREEK AZ
85142-1548
US

V. Phone/Fax

Practice location:
  • Phone: 702-420-8064
  • Fax: 702-438-4673
Mailing address:
  • Phone: 702-420-8064
  • Fax: 702-438-4673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: