1336866409 NPI number — KRISTI LORAINE ROBERTS MA, LLPC

Table of content: KRISTI LORAINE ROBERTS MA, LLPC (NPI 1336866409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336866409 NPI number — KRISTI LORAINE ROBERTS MA, LLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
KRISTI
Provider Middle Name:
LORAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LLPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336866409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15001 PINE RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND HAVEN
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49417-9702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-350-3384
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
890 WASHINGTON AVE STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLLAND
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49423-7702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-237-8898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2022

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: 101YS0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YS0200X , with the licence number: 6451022609 , 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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