Provider Demographics
NPI:1760235089
Name:MASSET, KRISTINA L
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:L
Last Name:MASSET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 DRAKE ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1944
Mailing Address - Country:US
Mailing Address - Phone:720-551-2551
Mailing Address - Fax:
Practice Address - Street 1:4710 EAGLERIDGE CIR STE 230
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2176
Practice Address - Country:US
Practice Address - Phone:720-551-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24-338048106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician