Provider Demographics
NPI:1043405293
Name:ROY, KRISTEN LOUISE (MASTERS LTD PSYCHOL)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LOUISE
Last Name:ROY
Suffix:
Gender:F
Credentials:MASTERS LTD PSYCHOL
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:LOUISE
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASTERS LTD PSYCHOL
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:801 HAZEN STREET SUITE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:430 BANGOR ROAD
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MI
Practice Address - Zip Code:49064
Practice Address - Country:US
Practice Address - Phone:269-674-4600
Practice Address - Fax:269-674-4126
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010289103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist