Provider Demographics
NPI:1790057461
Name:CLUTE, CHRISTINE PETERSEN (MA, LPC, LLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PETERSEN
Last Name:CLUTE
Suffix:
Gender:F
Credentials:MA, LPC, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 PECKENS RD
Mailing Address - Street 2:
Mailing Address - City:HONOR
Mailing Address - State:MI
Mailing Address - Zip Code:49640-9536
Mailing Address - Country:US
Mailing Address - Phone:231-871-0019
Mailing Address - Fax:
Practice Address - Street 1:109 S UNION ST
Practice Address - Street 2:STE 208
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2590
Practice Address - Country:US
Practice Address - Phone:231-871-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401003732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional