Provider Demographics
NPI:1275151631
Name:ANSEL, KRISTIN COLLEEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:COLLEEN
Last Name:ANSEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 NORWICH DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2630
Mailing Address - Country:US
Mailing Address - Phone:313-282-2282
Mailing Address - Fax:
Practice Address - Street 1:838 NORWICH DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2630
Practice Address - Country:US
Practice Address - Phone:313-282-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional