Provider Demographics
NPI:1104663954
Name:KINZLER, KRISTI KAY (MA, LPC)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:KAY
Last Name:KINZLER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5566 ALBRIGHT AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9780
Mailing Address - Country:US
Mailing Address - Phone:616-204-3718
Mailing Address - Fax:
Practice Address - Street 1:5360 CASCADE RD SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6404
Practice Address - Country:US
Practice Address - Phone:616-217-9934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007010101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional