Provider Demographics
NPI:1215290234
Name:RAETZ, ROBERT BURKE (LPC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BURKE
Last Name:RAETZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 HARBOR CT
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49685-9355
Mailing Address - Country:US
Mailing Address - Phone:231-645-8500
Mailing Address - Fax:231-946-6638
Practice Address - Street 1:923 HARBOR CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-9355
Practice Address - Country:US
Practice Address - Phone:231-645-8500
Practice Address - Fax:231-946-6638
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005810101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health