Provider Demographics
NPI:1235863960
Name:TRIPLETT, BRITNEY KRISTINE
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:KRISTINE
Last Name:TRIPLETT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:ICARUS
Other - Middle Name:
Other - Last Name:TRIPLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1212 CROSBY ST NW # 1
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-2913
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 CROSBY ST NW # 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-2913
Practice Address - Country:US
Practice Address - Phone:731-345-5668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician