Provider Demographics
NPI:1245941277
Name:PAGE, CHRIS THOMAS
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:THOMAS
Last Name:PAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4217 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROWN CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48416-7715
Mailing Address - Country:US
Mailing Address - Phone:810-728-3974
Mailing Address - Fax:
Practice Address - Street 1:6129 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-8137
Practice Address - Country:US
Practice Address - Phone:810-625-3250
Practice Address - Fax:810-270-5048
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician