Kristine Burgess, MA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6362009234 Issued in MI

Practice address

50258 Van Dyke Ave
Shelby Township, MI 48317-1374

Phone

(586) 884-4714

NPI assigned

Oct 5, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1578160347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50571 NEWCASTLE DR",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480471716",
            "telephone_number": "586-202-1426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50258 VAN DYKE AVE",
            "city": "SHELBY TOWNSHIP",
            "state": "MI",
            "postal_code": "483171374",
            "telephone_number": "586-884-4714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGESS",
        "first_name": "KRISTINE",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-05",
        "last_updated": "2020-10-05",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6362009234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "1225583248",
            "identifier": "813601247",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "2060",
            "affiliation": "N",
            "address_1": "50258 Van Dyke Ave",
            "city": "Shelby Township",
            "state": "MI",
            "country_code": "US",
            "postal_code": "483171374",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kathryn Therese Bruce, NATIONALLY CERTIFIED
• Raneen M Bseileh, RPH
• Mark Bshara, THE GODS CARE AGENCY
• Lana Renee Budde, M.A. CCC-SLP
• Rachel Lynn Bullard
• Raelle Burkhart, LMSW
• Emily Grace Burroughs, PA-C
• Darnell Burton, RPH
• Ara Nason Bush, M.D.
• Helen Yinnee Buyse, LMSW

• Clinical Psychologist in Shelby Township, MI
• Providers in Shelby Township, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.