Provider Demographics
NPI:1669818381
Name:BLACKMER, KRISTY (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:
Last Name:BLACKMER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1019
Mailing Address - Country:US
Mailing Address - Phone:517-526-3787
Mailing Address - Fax:
Practice Address - Street 1:405 W FRONT ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1019
Practice Address - Country:US
Practice Address - Phone:517-526-3787
Practice Address - Fax:888-622-1865
Is Sole Proprietor?:No
Enumeration Date:2013-05-21
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014911101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-4982648OtherITIN