Provider Demographics
NPI:1801161286
Name:BERNAT, KRISTEN KAY (MA, LPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAY
Last Name:BERNAT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:KAY
Other - Last Name:GALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:3604 CLARKSTON RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-5215
Mailing Address - Country:US
Mailing Address - Phone:248-840-6143
Mailing Address - Fax:
Practice Address - Street 1:3604 CLARKSTON RD
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-5215
Practice Address - Country:US
Practice Address - Phone:248-840-6143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional