Provider Demographics
NPI:1881726768
Name:REILLY, CHRISTOPHER MICHAEL (MFT36054)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:REILLY
Suffix:
Gender:M
Credentials:MFT36054
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 TRUXTUN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0523
Mailing Address - Country:US
Mailing Address - Phone:661-525-8505
Mailing Address - Fax:661-742-1606
Practice Address - Street 1:4200 TRUXTUN AVE STE 202
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0523
Practice Address - Country:US
Practice Address - Phone:661-525-8505
Practice Address - Fax:661-742-1606
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36054106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist