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NPI Code Detail

MEDICARE: KRISTIAN CRITTENDEN

MEDICARE: KRISTIAN CRITTENDEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst
2106S00000XBehavior TechnicianMI

General Provider Information

NPI Number : 1740741768
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIAN CRITTENDEN
Provider Business Mailing Address
First Line : 28116 ORCHARD LAKE RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-3713
Country : US
Telephone Number : 248-550-0333
Fax Number :
Provider Business Practice Location Address
First Line : 28116 ORCHARD LAKE RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48334-3713
Country : US
Telephone Number : 248-550-0333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2019
Last Update Date : 02/15/2023

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