Individual
KRISTINA ANN BOURDO-MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
2814 WOODCLIFF CIR SE, GRAND RAPIDS, MI 49506-3155
(855) 832-6727
Mailing address
338 N MAIN ST, WAYLAND, MI 49348-1039
(541) 610-7104
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
7401002527
MI
103K00000X
Behavior Analyst
—
MI
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
08/05/2016
Last updated
11/22/2024
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