Basic Information
| Provider Information | |||||||||
| NPI: | 1285911792 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LETT | ||||||||
| FirstName: | CHRISTIN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 TORREY RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484303327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104947180 | ||||||||
| FaxNumber: | 2486924936 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 GENOA BUSINESS PARK DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481145328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104497180 | ||||||||
| FaxNumber: | 2487151334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2011 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TF0200X | 6301014642 | MI | N | Behavioral Health & Social Service Providers | Psychologist | Forensic | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.