Provider Demographics
NPI:1073172714
Name:BACKHAUS, CHRISTAL RENEE
Entity Type:Individual
Prefix:MS
First Name:CHRISTAL
Middle Name:RENEE
Last Name:BACKHAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CHRISTAL
Other - Middle Name:RENEE
Other - Last Name:SADLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 DODGE RD
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1205
Mailing Address - Country:US
Mailing Address - Phone:716-831-2700
Mailing Address - Fax:
Practice Address - Street 1:3345 SOUTHWESTERN BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1506
Practice Address - Country:US
Practice Address - Phone:716-662-6802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor