Provider Demographics
NPI:1073091872
Name:TITTLE, CHRISTOPHER (MS, CMHC, LPC)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:
Last Name:TITTLE
Suffix:
Gender:M
Credentials:MS, CMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-3134
Mailing Address - Country:US
Mailing Address - Phone:801-628-3881
Mailing Address - Fax:
Practice Address - Street 1:204 W ADAMS AVE STE 213
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-2517
Practice Address - Country:US
Practice Address - Phone:801-628-3881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10350774-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health