Provider Demographics
NPI:1104044684
Name:CHRISTY, MICHAEL SCOTT JR (BS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:CHRISTY
Suffix:JR
Gender:M
Credentials:BS
Other - Prefix:
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Mailing Address - Street 1:3800 FULLER AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-2251
Mailing Address - Country:US
Mailing Address - Phone:616-447-8271
Mailing Address - Fax:
Practice Address - Street 1:721 N CENTER DR NW
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:MI
Practice Address - Zip Code:49544-8215
Practice Address - Country:US
Practice Address - Phone:616-647-2590
Practice Address - Fax:616-351-8249
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health