Provider Demographics
NPI:1073290250
Name:TRINNAMAN, KRISTEN (LCPC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:TRINNAMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2516
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83206-2516
Mailing Address - Country:US
Mailing Address - Phone:208-252-5621
Mailing Address - Fax:208-648-4167
Practice Address - Street 1:476 HERITAGE PARK BLVD STE 230
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5636
Practice Address - Country:US
Practice Address - Phone:801-896-5345
Practice Address - Fax:801-896-5334
Is Sole Proprietor?:No
Enumeration Date:2023-06-29
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13409821-6009101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional