Basic Information
| Provider Information | |||||||||
| NPI: | 1972995785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KROZAL | ||||||||
| FirstName: | KRISTINA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1615 MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493047984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317454624 | ||||||||
| FaxNumber: | 2317455031 | ||||||||
| Practice Location | |||||||||
| Address1: | 1035 E WILCOX AVE | ||||||||
| Address2: | |||||||||
| City: | WHITE CLOUD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493498794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316895943 | ||||||||
| FaxNumber: | 2316891590 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2015 | ||||||||
| LastUpdateDate: | 05/20/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 6401014670 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.