Provider Demographics
NPI:1033179007
Name:MOYER, CHRISTINE N (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:N
Last Name:MOYER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N CENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-6733
Mailing Address - Country:US
Mailing Address - Phone:480-649-3111
Mailing Address - Fax:480-649-3113
Practice Address - Street 1:303 N CENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-6733
Practice Address - Country:US
Practice Address - Phone:480-649-3111
Practice Address - Fax:480-649-3113
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ415663Medicaid
Z74169Medicare PIN
S26973Medicare UPIN
AZ415663Medicaid
AZZ148850Medicare PIN
Z120235Medicare PIN