Provider Demographics
NPI:1700901964
Name:CRISTO REY COMMUNITY CENTER
Entity Type:Organization
Organization Name:CRISTO REY COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM & CLINICAL DIRECTOR OF COUN
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, CAAC, CSW
Authorized Official - Phone:517-372-4700
Mailing Address - Street 1:1717 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48906-4529
Mailing Address - Country:US
Mailing Address - Phone:517-372-4700
Mailing Address - Fax:517-372-3314
Practice Address - Street 1:1717 N HIGH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4529
Practice Address - Country:US
Practice Address - Phone:517-372-4700
Practice Address - Fax:517-372-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330041101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3148943Medicaid