Provider Demographics
NPI:1538412689
Name:HJELMSTAD, KRISTEN (LMSW, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HJELMSTAD
Suffix:
Gender:F
Credentials:LMSW, BCBA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:CYRUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:79 W ALEXANDRINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2015
Mailing Address - Country:US
Mailing Address - Phone:313-831-5535
Mailing Address - Fax:313-831-2608
Practice Address - Street 1:955 CAMPUS DRIVE NORTH
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328
Practice Address - Country:US
Practice Address - Phone:248-451-2955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MI68010894851041C0700X
MI1-14-17043103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical