Provider Demographics
NPI:1689907586
Name:GOLDBACH, KRISTINA L (MMFT,BFA,LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:GOLDBACH
Suffix:
Gender:F
Credentials:MMFT,BFA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13125 W 2ND PL APT C2533
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1476
Mailing Address - Country:US
Mailing Address - Phone:510-350-6849
Mailing Address - Fax:
Practice Address - Street 1:13125 W 2ND PL APT C2533
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1476
Practice Address - Country:US
Practice Address - Phone:510-350-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13558131OtherCAQH
CTPENDINGOtherCIGNA BEHAVIORAL HEALTH
CTPENDINGOtherMHN-TRICARE NORTH
CTNOT ELIGIBLEMedicare PIN
CT060669107OtherANTHEM BCBS OF CT BEHAVIORAL HEALTH-WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED BEHAVIORAL HEALTH-WELLMORE GRP/FACILITY
CTPENDINGOtherAETNA BEHAVIORAL HEALTH
CTPENDINGMedicaid
CT060669107OtherHEALTHY CT- WELLMORE GRP/FACILITY
CT060669107OtherUBH-OXFORD LIBERTY /OXFORD FREEDOM- WELLMORE GRP/FACILITY
CT13558131OtherCAQH
CTPENDINGOtherMHN MANAGED HEALTH NETWORK
CT060669107OtherUBH-CONNECTICARE WELLMORE-GRP/FACILITY
CTD339209OtherVALUE OPTIONS