Provider Demographics
NPI:1205233764
Name:JEANETTE, KRISTEN (DBH, MA, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:JEANETTE
Suffix:
Gender:
Credentials:DBH, MA, LPC, NCC
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:JEANETTE
Other - Last Name:KENNARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DBH, LPC, NCC, PMH-C
Mailing Address - Street 1:18497 ROSELAWN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3011 W GRAND BLVD STE 418
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3011
Practice Address - Country:US
Practice Address - Phone:248-266-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-29
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018571101YP2500X
MI6401014563101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional