Provider Demographics
NPI:1134479900
Name:THAYN, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:THAYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BRADFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:231 DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:RANGELY
Mailing Address - State:CO
Mailing Address - Zip Code:81648-2803
Mailing Address - Country:US
Mailing Address - Phone:435-419-0133
Mailing Address - Fax:
Practice Address - Street 1:231 DAKOTA AVE
Practice Address - Street 2:
Practice Address - City:RANGELY
Practice Address - State:CO
Practice Address - Zip Code:81648-2803
Practice Address - Country:US
Practice Address - Phone:435-419-0133
Practice Address - Fax:970-548-4001
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014546103TC1900X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling