Healthcare Provider Details

I. General information

NPI: 1265655138
Provider Name (Legal Business Name): CHRISTOPHER JOHN NICHOLLS PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8687 E VIA DE VENTURA SUITE 113
SCOTTSDALE AZ
85258-3347
US

IV. Provider business mailing address

PO BOX 6159
SCOTTSDALE AZ
85261-6159
US

V. Phone/Fax

Practice location:
  • Phone: 480-998-2303
  • Fax: 480-998-3169
Mailing address:
  • Phone: 480-998-2303
  • Fax: 480-998-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1139
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1139
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number1139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: