Healthcare Provider Details

I. General information

NPI: 1104663954
Provider Name (Legal Business Name): KRISTI KAY KINZLER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 CASCADE RD SE
GRAND RAPIDS MI
49546-6404
US

IV. Provider business mailing address

5566 ALBRIGHT AVE SW
WYOMING MI
49418-9780
US

V. Phone/Fax

Practice location:
  • Phone: 616-217-9934
  • Fax:
Mailing address:
  • Phone: 616-204-3718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401007010
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: