Provider Demographics
NPI:1568652055
Name:CHISHOLM, CHRISTINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CHISHOLM TURES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:FLAGSTAFF MEDICAL CENTER BEHAVIORAL HEALTH SERVICES 2ND
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001
Mailing Address - Country:US
Mailing Address - Phone:928-213-6410
Mailing Address - Fax:928-213-6409
Practice Address - Street 1:1200 N BEAVER ST
Practice Address - Street 2:FLAGSTAFF MEDICAL CENTER BEHAVIORAL HEALTH SERVICES 2ND
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001
Practice Address - Country:US
Practice Address - Phone:928-213-6410
Practice Address - Fax:928-213-6409
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW1918104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
S10092Medicare UPIN