Basic Information
| Provider Information | |||||||||
| NPI: | 1700460227 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IRVINE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Credential: | MA, LLPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11218 BRICKAND DR | ||||||||
| Address2: | |||||||||
| City: | GRAND LEDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488378458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205624461 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1701 LAKE LANSING RD STE 120 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489123798 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104947180 | ||||||||
| FaxNumber: | 8102151334 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.