Provider Demographics
NPI:1568003200
Name:PENCE, KRISTIN (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:PENCE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:PENCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:440 S STATE ST STE 320
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-2250
Mailing Address - Country:US
Mailing Address - Phone:616-422-7820
Mailing Address - Fax:
Practice Address - Street 1:440 S STATE ST STE 320
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2250
Practice Address - Country:US
Practice Address - Phone:616-422-7820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-03
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
MI6401015448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist