Provider Demographics
NPI:1649710575
Name:HARRIS, CHRISTOPHER CHARLES (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:CHARLES
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15510 CALLAHAN
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2723
Mailing Address - Country:US
Mailing Address - Phone:313-802-3945
Mailing Address - Fax:
Practice Address - Street 1:15510 CALLAHAN
Practice Address - Street 2:
Practice Address - City:FRASER
Practice Address - State:MI
Practice Address - Zip Code:48026-2723
Practice Address - Country:US
Practice Address - Phone:313-802-3945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014936101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401014936OtherSTATE OF MICHIGAN