Provider Demographics
NPI:1538477765
Name:BURTAINE, KRISTIN LEE (MA, LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEE
Last Name:BURTAINE
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEE
Other - Last Name:FRANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1715 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3019
Mailing Address - Country:US
Mailing Address - Phone:616-633-0476
Mailing Address - Fax:
Practice Address - Street 1:1715 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3019
Practice Address - Country:US
Practice Address - Phone:616-633-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health