Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 5201009710 | MI |
NPI | 1265186175 |
---|---|
Provider Name | Krystal L Morin |
First Address | Flint, MI 48506-4729 |
Second Address | Flint, MI 48505-1501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2022 |
Last Update Date | 09/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5201009710 | OCCUPATIONAL THERAPIST LICENSE (01) | MI |