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NPI Code Detail

MEDICARE: CHRISTINE PETERSEN CLUTE M.A., L.P.C., L.L.P.

MEDICARE: CHRISTINE PETERSEN CLUTE M.A., L.P.C., L.L.P.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor6401003732MI

General Provider Information

NPI Number : 1790057461
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINE PETERSEN CLUTE M.A., L.P.C., L.L.P.
Provider Business Mailing Address
First Line : 2960 PECKENS RD
Second Line :
City : HONOR
State : MI
Zip : 49640-9536
Country : US
Telephone Number : 231-871-0019
Fax Number :
Provider Business Practice Location Address
First Line : 109 S UNION ST
Second Line : STE 208
City : TRAVERSE CITY
State : MI
Zip : 49684-2590
Country : US
Telephone Number : 231-871-0019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2012
Last Update Date : 01/27/2012

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