MEDICARE: DARYL CHRISTOPHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1497350664
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL CHRISTOPHER

Provider Business Mailing Address
First Line	:	717 E HARWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6655
Country	:	US
Telephone Number	:	702-266-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	6373 COPPERFIELD AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-1728
Country	:	US
Telephone Number	:	702-266-6443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/08/2020

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Directions to “ DARYL CHRISTOPHER ” Practice Location

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