Provider Demographics
NPI:1467945048
Name:MCKELVY, CHRISTINA (LPC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:MCKELVY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:KNOWLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 11380
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1380
Mailing Address - Country:US
Mailing Address - Phone:928-517-7200
Mailing Address - Fax:928-517-7500
Practice Address - Street 1:450 W GOODWIN ST STE 103B
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-3781
Practice Address - Country:US
Practice Address - Phone:928-517-7200
Practice Address - Fax:928-517-7500
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17075101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ396477Medicaid