Provider Demographics
NPI:1083314843
Name:KING, KRISTEN (CAT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:CAT
Other - Prefix:
Other - First Name:NOVA
Other - Middle Name:ROSE
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAT
Mailing Address - Street 1:4856 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-5540
Mailing Address - Country:US
Mailing Address - Phone:970-397-7815
Mailing Address - Fax:
Practice Address - Street 1:4856 INNOVATION DR STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-5540
Practice Address - Country:US
Practice Address - Phone:970-397-7815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACA.0008257101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)