Provider Demographics
NPI:1245325331
Name:VANSTEE, CHRISTOPHER MARTIN (MA,TLLP, LBSW, CAADC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MARTIN
Last Name:VANSTEE
Suffix:
Gender:M
Credentials:MA,TLLP, LBSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-0075
Mailing Address - Country:US
Mailing Address - Phone:616-522-0687
Mailing Address - Fax:616-522-0725
Practice Address - Street 1:215 W. MAIN ST.
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-7506
Practice Address - Country:US
Practice Address - Phone:616-522-0687
Practice Address - Fax:616-522-0725
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-02976101YA0400X
MI6802071225104100000X
MI6301015761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid