1356750251 NPI number — CHRISTINE FOSTER SEBURG M.A., LPC, NCC

Table of content: CHRISTINE FOSTER SEBURG M.A., LPC, NCC (NPI 1356750251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356750251 NPI number — CHRISTINE FOSTER SEBURG M.A., LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEBURG
Provider First Name:
CHRISTINE
Provider Middle Name:
FOSTER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTER
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LPC, NCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356750251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3027 PASADENA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAMAZOO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49001-4421
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-807-6087
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2047 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALAMAZOO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49006-3040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-381-8191
Provider Business Practice Location Address Fax Number:
269-312-8827
Provider Enumeration Date:
08/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401014438 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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