Provider Demographics
NPI:1679106694
Name:RITTHALER, KARISSA (BCABA, LBA)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:
Last Name:RITTHALER
Suffix:
Gender:F
Credentials:BCABA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10848 BIG LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DAVISBURG
Mailing Address - State:MI
Mailing Address - Zip Code:48350-3604
Mailing Address - Country:US
Mailing Address - Phone:248-872-5655
Mailing Address - Fax:
Practice Address - Street 1:10435 ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1979
Practice Address - Country:US
Practice Address - Phone:248-605-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI02113310106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst