Active NPI
Kristina Ann Bourdo-Moulder, BCBA, LBA
- Behavior Analyst
- Grand Rapids, MI
National Provider Identifier
1609320811
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 7401002527
- Practice address
- 2814 Woodcliff Cir SE
Grand Rapids, MI 49506-3155 - Phone
- (855) 832-6727
- NPI assigned
- Aug 5, 2016
- Last updated
- Nov 22, 2024
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | |||
| Behavior Analyst | 103K00000X | 7401002527 | MI | Primary |
| Mental Health Counselor | 101YM0800X | |||
| Behavior Analyst | 103K00000X | MI | ||
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
2814 Woodcliff Cir SE
Grand Rapids, MI 49506-3155
Mailing address
338 N Main St
Wayland, MI 49348-1039
Phone (541) 610-7104
Other practice location 1
27777 Inkster Rd Ste 100
Farmington Hills, MI 48334-5312
Phone (248) 436-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7401002527 | MI | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732233600000",
"number": "1609320811",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "338 N MAIN ST",
"city": "WAYLAND",
"state": "MI",
"postal_code": "493481039",
"telephone_number": "541-610-7104"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2814 WOODCLIFF CIR SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495063155",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [
{
"address_1": "27777 Inkster Rd Ste 100",
"address_purpose": "LOCATION",
"city": "Farmington Hills",
"state": "MI",
"postal_code": "483345312",
"country_code": "US",
"telephone_number": "248-436-4400",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BOURDO-MOULDER",
"first_name": "KRISTINA",
"middle_name": "ANN",
"credential": "BCBA, LBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-05",
"last_updated": "2024-11-22",
"certification_date": "2024-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": "7401002527",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.