Provider Demographics
NPI:1336626837
Name:AMANTE, CHRISTINE LOUISE (MED, LLP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LOUISE
Last Name:AMANTE
Suffix:
Gender:F
Credentials:MED, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 HENRY ST # 120
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3509
Mailing Address - Country:US
Mailing Address - Phone:231-206-4844
Mailing Address - Fax:231-798-2908
Practice Address - Street 1:318 HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-1911
Practice Address - Country:US
Practice Address - Phone:231-206-4844
Practice Address - Fax:231-798-2908
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007378103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling