Provider Demographics
NPI:1891970653
Name:GRUBB, CHRISINE PETRUS (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISINE
Middle Name:PETRUS
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 E CACTUS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7196
Mailing Address - Country:US
Mailing Address - Phone:602-494-7906
Mailing Address - Fax:
Practice Address - Street 1:3040 E CACTUS RD
Practice Address - Street 2:SUITE A
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7196
Practice Address - Country:US
Practice Address - Phone:602-494-7906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0961103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist