Healthcare Provider Details

I. General information

NPI: 1134039530
Provider Name (Legal Business Name): CHRISTINA FTACEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 BARFIELD DR
HASTINGS MI
49058-9018
US

IV. Provider business mailing address

500 BARFIELD DR
HASTINGS MI
49058-9018
US

V. Phone/Fax

Practice location:
  • Phone: 269-948-8041
  • Fax: 269-948-9319
Mailing address:
  • Phone: 269-948-8041
  • Fax: 269-948-9319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451025384
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: