MEDICARE: STEPHANIE CHRISTIANSON MC, LAC

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	101Y00000X	Counselor	LAC-08362T	AZ

General Provider Information

NPI Number	:	1841002466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CHRISTIANSON MC, LAC

Provider Business Mailing Address
First Line	:	3432 E LINDA LN
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-4210
Country	:	US
Telephone Number	:	602-730-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 E MISSOURI AVE STE 400
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-2704
Country	:	US
Telephone Number	:	602-730-6554
Fax Number	:

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

Provider Enumeration Date	:	01/21/2025
Last Update Date	:	12/10/2025

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