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General NPI Number Information
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NPI Number | 1497350664
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Entity Type | Individual
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Provider Name | DARYL CHRISTOPHER
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Gender | Male
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/08/2020
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Provider Practice Location Address
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Address Line | 6373 COPPERFIELD AVE
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City | LAS VEGAS
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State | NV
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Zip | 89108-1728
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Country | US
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Telephone | 702-266-6443
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Fax |
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Provider Business Mailing Address
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Address Line | 717 E HARWELL RD
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City | PHOENIX
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State | AZ
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Zip | 85042-6655
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Country | US
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Telephone | 702-266-6443
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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