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General NPI Number Information
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NPI Number | 1225594187
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Entity Type | Organization
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Legal Business Name | R CHRISTOPHER DEBOER PLLC
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Dates
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Enumeration Date | 02/15/2019
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Last Update Date | 06/26/2020
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Provider Practice Location Address
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Address Line | 2395 JOLLY RD STE 160
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City | OKEMOS
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State | MI
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Zip | 48864-5977
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Country | US
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Telephone | 517-918-4371
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Fax |
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Provider Business Mailing Address
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Address Line | 433 DORRANCE PL
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City | LANSING
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State | MI
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Zip | 48912-1501
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Country | US
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Telephone | 517-918-4371
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MR. RYAN CHRISTOPHER DEBOER
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Credential | LPC
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Telephone | 517-918-4371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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