Healthcare Provider Details

I. General information

NPI: 1952694507
Provider Name (Legal Business Name): CHRIS NEIL RENDON RABANERA LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS RENDON RABANERA LMFT

II. Dates (important events)

Enumeration Date: 05/16/2011
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BUSCHLEN RD STE 101
BAD AXE MI
48413-9177
US

IV. Provider business mailing address

75 BUSCHLEN RD STE 101
BAD AXE MI
48413-9177
US

V. Phone/Fax

Practice location:
  • Phone: 989-623-9300
  • Fax: 760-788-9754
Mailing address:
  • Phone: 989-623-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 63843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: