Healthcare Provider Details

I. General information

NPI: 1336064823
Provider Name (Legal Business Name): CRISTA PROCOPIO NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 W VAN BUREN ST
TOLLESON AZ
85353-2833
US

IV. Provider business mailing address

9801 W VAN BUREN ST
TOLLESON AZ
85353-2833
US

V. Phone/Fax

Practice location:
  • Phone: 480-459-8157
  • Fax:
Mailing address:
  • Phone: 480-459-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number5217182
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: