Provider Demographics
NPI:1720045081
Name:ABRAITIS, JOHN A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:ABRAITIS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E COLUMBIA AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-3788
Mailing Address - Country:US
Mailing Address - Phone:269-660-1111
Mailing Address - Fax:269-660-1111
Practice Address - Street 1:131 E COLUMBIA AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-3788
Practice Address - Country:US
Practice Address - Phone:269-660-1111
Practice Address - Fax:269-660-1111
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680A34534OtherBCBS
MI680A34534OtherBCBS