Provider Demographics
NPI:1386116812
Name:OTTO, CHRISTINA RENEE (LLMSW, DP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENEE
Last Name:OTTO
Suffix:
Gender:F
Credentials:LLMSW, DP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 W BLUE GRASS RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-9566
Mailing Address - Country:US
Mailing Address - Phone:989-400-0773
Mailing Address - Fax:
Practice Address - Street 1:2800 S SHEPHERD RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858-8966
Practice Address - Country:US
Practice Address - Phone:989-775-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011034051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical