Provider Demographics
NPI:1225455272
Name:KRISTEN HUSTED
Entity Type:Organization
Organization Name:KRISTEN HUSTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HUSTED
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-499-9852
Mailing Address - Street 1:4500 ASCOT CT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48306-4720
Mailing Address - Country:US
Mailing Address - Phone:248-499-9852
Mailing Address - Fax:
Practice Address - Street 1:4500 ASCOT CT
Practice Address - Street 2:
Practice Address - City:OAKLAND TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48306-4720
Practice Address - Country:US
Practice Address - Phone:248-499-9852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801086548251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health