Provider Demographics
NPI:1396298808
Name:BRUMM, CHRISTOPHER (MA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:BRUMM
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 BOSTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-2466
Mailing Address - Country:US
Mailing Address - Phone:269-806-4116
Mailing Address - Fax:
Practice Address - Street 1:2413 BOSTON BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2466
Practice Address - Country:US
Practice Address - Phone:517-798-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-17-25546103K00000X
MI7401000181103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst