Provider Demographics
NPI:1689281024
Name:SOBEL, CHRISTOPHER S (MS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:S
Last Name:SOBEL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 E AMBER RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-7903
Mailing Address - Country:US
Mailing Address - Phone:928-273-4302
Mailing Address - Fax:
Practice Address - Street 1:214 N ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3104
Practice Address - Country:US
Practice Address - Phone:928-776-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLASAC-15417101YA0400X
AZLASAC-6715T101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLASAC-15417OtherSTATE OF ARIZONA BOARD OF BEHAVIORIAL HEALTH EXAMINERS
AZLASAC-6715TOtherSTATE OF ARIZONA BOARD OF BEHAVIORIAL HEALTH EXAMINERS