Provider Demographics
NPI:1952694507
Name:RABANERA, CHRIS NEIL RENDON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHRIS NEIL
Middle Name:RENDON
Last Name:RABANERA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:MR
Other - First Name:CHRIS
Other - Middle Name:RENDON
Other - Last Name:RABANERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:75 BUSCHLEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9177
Mailing Address - Country:US
Mailing Address - Phone:989-623-9300
Mailing Address - Fax:
Practice Address - Street 1:75 BUSCHLEN RD STE 101
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9177
Practice Address - Country:US
Practice Address - Phone:989-623-9300
Practice Address - Fax:760-788-9754
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 63843106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4101006876OtherSTATE LICENSE