Healthcare Provider Details

I. General information

NPI: 1376102384
Provider Name (Legal Business Name): BRIANA CRIST-BURIN LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 07/12/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 E BELTLINE AVE NE STE 202
GRAND RAPIDS MI
49525-6869
US

IV. Provider business mailing address

814 BURKE AVE NE
GRAND RAPIDS MI
49503-1925
US

V. Phone/Fax

Practice location:
  • Phone: 616-740-3381
  • Fax: 616-226-4603
Mailing address:
  • Phone: 248-506-4296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008340
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: