Provider Demographics
NPI:1316560261
Name:VAN DER POEL, KRISTIN (LPC, MFTC, NCC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:VAN DER POEL
Suffix:
Gender:F
Credentials:LPC, MFTC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N HARRISON AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2310
Mailing Address - Country:US
Mailing Address - Phone:720-378-4325
Mailing Address - Fax:
Practice Address - Street 1:104 N HARRISON AVE UNIT A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2310
Practice Address - Country:US
Practice Address - Phone:720-378-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFTC.0013793106H00000X
COLPC.0015740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist