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General NPI Number Information
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NPI Number | 1831887892
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Entity Type | Individual
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Provider Name | LISA MARIE CRIST LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/27/2023
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 8765 W KELTON LN BLDG A2B3
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City | PEORIA
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State | AZ
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Zip | 85382-3584
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Country | US
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Telephone | 602-613-0403
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W SEQUOIA DR
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City | PHOENIX
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State | AZ
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Zip | 85027-4753
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Country | US
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Telephone | 623-261-2983
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-21170
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License Number State | AZ
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