Provider Demographics
NPI:1013244193
Name:FRIAS, KRISTINE JANE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:JANE
Last Name:FRIAS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1788 BOWERS ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6885
Mailing Address - Country:US
Mailing Address - Phone:248-212-7294
Mailing Address - Fax:
Practice Address - Street 1:1788 BOWERS ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6885
Practice Address - Country:US
Practice Address - Phone:248-212-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
MI6801091043104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist