Provider Demographics
NPI:1376743104
Name:HIBBERT, CHRISTINA GRAMPP (PSYD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:GRAMPP
Last Name:HIBBERT
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 1:2388 N BROKEN CIRCLE RD
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-7531
Mailing Address - Country:US
Mailing Address - Phone:602-361-7364
Mailing Address - Fax:928-774-0300
Practice Address - Street 1:710 N BEAVER ST BLDG 2-2
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3145
Practice Address - Country:US
Practice Address - Phone:928-774-7997
Practice Address - Fax:928-774-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3710103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical