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General NPI Number Information
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NPI Number | 1104430016
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Entity Type | Individual
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Provider Name | CHRISTOPHER ROBERT PEASE LPC
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Gender | Male
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Dates
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Enumeration Date | 09/08/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 509 FRANKLIN AVE
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City | GRAND HAVEN
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State | MI
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Zip | 49417-1400
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Country | US
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Telephone | 616-402-0514
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Fax |
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Provider Business Mailing Address
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Address Line | 12375 OAKRIDGE CT
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City | GRAND HAVEN
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State | MI
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Zip | 49417-9796
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Country | US
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Telephone | 616-928-4838
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6401018465
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License Number State | MI
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