Healthcare Provider Details

I. General information

NPI: 1902256449
Provider Name (Legal Business Name): EDWARD ALTENRITTER MA, CRC LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 UNIVERSITY PARK DR
OKEMOS MI
48864-5938
US

IV. Provider business mailing address

2111 UNIVERSITY PARK DRIVE
OKEMOS MI
48864
US

V. Phone/Fax

Practice location:
  • Phone: 517-336-4335
  • Fax: 517-336-0101
Mailing address:
  • Phone: 517-336-4335
  • Fax: 517-336-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401000102
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: