Provider Demographics
NPI:1245467943
Name:DELANGE, KRISTEN M (MS, LPC, NCC, CAADC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:DELANGE
Suffix:
Gender:F
Credentials:MS, LPC, NCC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 WINDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3236
Mailing Address - Country:US
Mailing Address - Phone:616-566-6175
Mailing Address - Fax:855-247-7439
Practice Address - Street 1:1899 ORCHARD LAKE RD STE 203B
Practice Address - Street 2:
Practice Address - City:SYLVAN LAKE
Practice Address - State:MI
Practice Address - Zip Code:48320-1776
Practice Address - Country:US
Practice Address - Phone:248-214-2261
Practice Address - Fax:855-247-7439
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011327101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1712452Medicaid
MI20366Medicare UPIN
MI750910519Medicare UPIN
MI750910532Medicare UPIN
MI750910517Medicare UPIN
MI750910513Medicare UPIN
MI750910527Medicare UPIN
MI750910530Medicare UPIN
MI1712452Medicaid
MI750910482Medicare UPIN
MI20378Medicare UPIN
MI750910524Medicare UPIN
MIOP22320Medicare PIN
MI20386Medicare UPIN