Provider Demographics
NPI:1700381225
Name:REISS, CHRISTINE LORI (MA, MAT, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:LORI
Last Name:REISS
Suffix:
Gender:F
Credentials:MA, MAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13542 HIDDEN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-8934
Mailing Address - Country:US
Mailing Address - Phone:616-402-0376
Mailing Address - Fax:
Practice Address - Street 1:13542 HIDDEN CREEK CT
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-8934
Practice Address - Country:US
Practice Address - Phone:616-402-0376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional