Provider Demographics
NPI:1407877327
Name:TENNEY-BLACKWELL, KRISTIN ANN (MA, TLLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:ANN
Last Name:TENNEY-BLACKWELL
Suffix:
Gender:F
Credentials:MA, TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N JEFFERSON ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1552
Mailing Address - Country:US
Mailing Address - Phone:269-781-4443
Mailing Address - Fax:
Practice Address - Street 1:111 N JEFFERSON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1552
Practice Address - Country:US
Practice Address - Phone:269-781-4443
Practice Address - Fax:269-781-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013134103TC2200X, 103TB0200X, 103TF0000X, 103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical