Provider Demographics
NPI:1053692046
Name:WHALEN, CHRISTINA (PHD, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-4103
Mailing Address - Country:US
Mailing Address - Phone:602-218-8223
Mailing Address - Fax:
Practice Address - Street 1:300 N 18TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-4103
Practice Address - Country:US
Practice Address - Phone:602-218-8223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-03-1463103K00000X
CAPSY19282103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst