Provider Demographics
NPI:1679813125
Name:CHRIS, JUSTYN MICHAEL (ACMHC, SUDC)
Entity Type:Individual
Prefix:
First Name:JUSTYN
Middle Name:MICHAEL
Last Name:CHRIS
Suffix:
Gender:M
Credentials:ACMHC, SUDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3739 E CRIMSON FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1897
Mailing Address - Country:US
Mailing Address - Phone:435-668-4848
Mailing Address - Fax:
Practice Address - Street 1:54 N 200 E
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-2615
Practice Address - Country:US
Practice Address - Phone:435-586-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6851312-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health