Provider Demographics
NPI:1346684891
Name:LINDBERG, KRISTY KAY (MA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:KAY
Last Name:LINDBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 W GRAND RIVER AVE
Mailing Address - Street 2:762
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-2392
Mailing Address - Country:US
Mailing Address - Phone:586-243-1378
Mailing Address - Fax:
Practice Address - Street 1:794 W GRAND RIVER AVE
Practice Address - Street 2:762
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2392
Practice Address - Country:US
Practice Address - Phone:586-243-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional