Provider Demographics
NPI:1376937128
Name:HALLISSEY, CHRISTOPHER PAUL (CRC RMHCINTERN)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PAUL
Last Name:HALLISSEY
Suffix:
Gender:M
Credentials:CRC RMHCINTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7627 SOUTHERN BROOK BND
Mailing Address - Street 2:103
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-1859
Mailing Address - Country:US
Mailing Address - Phone:201-264-2830
Mailing Address - Fax:
Practice Address - Street 1:7627 SOUTHERN BROOK BND
Practice Address - Street 2:103
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-1859
Practice Address - Country:US
Practice Address - Phone:201-264-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health