Provider Demographics
NPI:1184121485
Name:HERRIMAN, KRISTEN LYNN
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:HERRIMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 VANTAGE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9211
Mailing Address - Country:US
Mailing Address - Phone:231-675-2136
Mailing Address - Fax:
Practice Address - Street 1:185 VANTAGE VIEW DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9211
Practice Address - Country:US
Practice Address - Phone:231-675-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional