Provider Demographics
NPI:1114048766
Name:REITZEL, CHRISTINE MARIE (MS, LLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:REITZEL
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33646 ALTA ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48135-1081
Mailing Address - Country:US
Mailing Address - Phone:734-261-0378
Mailing Address - Fax:
Practice Address - Street 1:1522 JOY AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-1933
Practice Address - Country:US
Practice Address - Phone:517-782-2551
Practice Address - Fax:517-783-1986
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P23230Medicare PIN