Healthcare Provider Details

I. General information

NPI: 1992476345
Provider Name (Legal Business Name): CHRISTOPHER SPENCER-MCKENNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1527 E LOUIS WAY
TEMPE AZ
85284-1622
US

IV. Provider business mailing address

1527 E LOUIS WAY
TEMPE AZ
85284-1622
US

V. Phone/Fax

Practice location:
  • Phone: 480-283-4674
  • Fax: 480-350-3345
Mailing address:
  • Phone: 480-283-4674
  • Fax: 480-350-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-16-24303
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: