Provider Demographics
NPI:1659899045
Name:MARICOPA CHRISTIAN PSYCHIATRY GROUP, LLC
Entity Type:Organization
Organization Name:MARICOPA CHRISTIAN PSYCHIATRY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:N
Authorized Official - Last Name:OLLOH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:480-284-8344
Mailing Address - Street 1:3130 N ARIZONA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-7162
Mailing Address - Country:US
Mailing Address - Phone:480-284-8344
Mailing Address - Fax:480-284-8622
Practice Address - Street 1:3130 N ARIZONA AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-7162
Practice Address - Country:US
Practice Address - Phone:480-284-8344
Practice Address - Fax:480-284-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty