Healthcare Provider Details

I. General information

NPI: 1225594187
Provider Name (Legal Business Name): R CHRISTOPHER DEBOER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2395 JOLLY RD STE 160
OKEMOS MI
48864-5977
US

IV. Provider business mailing address

433 DORRANCE PL
LANSING MI
48912-1501
US

V. Phone/Fax

Practice location:
  • Phone: 517-918-4371
  • Fax:
Mailing address:
  • Phone: 517-918-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN CHRISTOPHER DEBOER
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 517-918-4371