Provider Demographics
NPI:1710543475
Name:KRISTINA RYNES PH.D. LLC
Entity Type:Organization
Organization Name:KRISTINA RYNES PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESCRIBING PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-750-8462
Mailing Address - Street 1:8810 VIDAL RD SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-7826
Mailing Address - Country:US
Mailing Address - Phone:505-750-8462
Mailing Address - Fax:
Practice Address - Street 1:122 TULANE DR SE STE 4
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1468
Practice Address - Country:US
Practice Address - Phone:505-750-8462
Practice Address - Fax:505-349-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-17
Last Update Date:2023-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)