Provider Demographics
NPI:1174144646
Name:GLASPER, CHRISTINE ELISE (LPC, SCL)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ELISE
Last Name:GLASPER
Suffix:
Gender:F
Credentials:LPC, SCL
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:ELISE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, SCL
Mailing Address - Street 1:19 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-1925
Mailing Address - Country:US
Mailing Address - Phone:248-895-2750
Mailing Address - Fax:
Practice Address - Street 1:19 RUTH AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-1925
Practice Address - Country:US
Practice Address - Phone:248-895-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIIF0000000336251101YS0200X
MI6401012053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty