Provider Demographics
NPI:1902256449
Name:ALTENRITTER, EDWARD (MA, CRC LPC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:ALTENRITTER
Suffix:
Gender:M
Credentials:MA, CRC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 UNIVERSITY PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864
Mailing Address - Country:US
Mailing Address - Phone:517-336-4335
Mailing Address - Fax:517-336-0101
Practice Address - Street 1:2111 UNIVERSITY PARK DR
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-5938
Practice Address - Country:US
Practice Address - Phone:517-336-4335
Practice Address - Fax:517-336-0101
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401000102101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor