Provider Demographics
NPI:1356361521
Name:ROBBE, CHANTELLE MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CHANTELLE
Middle Name:MARIE
Last Name:ROBBE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CHANTELLE
Other - Middle Name:MARIE
Other - Last Name:BROCHU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6322 TROTWOOD ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-3251
Mailing Address - Country:US
Mailing Address - Phone:616-402-0364
Mailing Address - Fax:
Practice Address - Street 1:1651 W CENTRE AVE STE 209
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-5321
Practice Address - Country:US
Practice Address - Phone:269-366-0650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010826691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1356361521OtherBLUE CROSS BLUE SHIELD