Provider Demographics
NPI:1497890164
Name:FEICK, CHRISTINE ELIZABETH (LP)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ELIZABETH
Last Name:FEICK
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-2332
Mailing Address - Country:US
Mailing Address - Phone:734-639-2262
Mailing Address - Fax:734-621-5075
Practice Address - Street 1:23 W 1ST ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-2332
Practice Address - Country:US
Practice Address - Phone:734-639-2262
Practice Address - Fax:734-621-5075
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861361041C0700X
MI6301015003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P63070Medicare UPIN