MEDICARE: MR. CHRIS NEIL RENDON RABANERA LMFT

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
1	106H00000X	Marriage & Family Therapist	IMF 63843	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4101006876	OTHER	MI	STATE LICENSE

General Provider Information

NPI Number	:	1952694507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS NEIL RENDON RABANERA LMFT

Provider Business Mailing Address
First Line	:	75 BUSCHLEN RD STE 101
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-9177
Country	:	US
Telephone Number	:	989-623-9300
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 BUSCHLEN RD STE 101
Second Line	:
City	:	BAD AXE
State	:	MI
Zip	:	48413-9177
Country	:	US
Telephone Number	:	989-623-9300
Fax Number	:	760-788-9754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	05/07/2021

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