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General NPI Number Information
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NPI Number | 1225409220
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Entity Type | Individual
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Provider Name | CHRISTIAN ROBERT KOMOR PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 235 LOUIS ST NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2600
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Country | US
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Telephone | 616-706-6951
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Fax |
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Provider Business Mailing Address
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Address Line | 428 CHILDERS ST PMB 24256
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City | PENSACOLA
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State | FL
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Zip | 32534-9630
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Country | US
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Telephone | 616-706-6951
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301005480
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License Number State | MI
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