Provider Demographics
NPI:1821769472
Name:MCCOLLOUGH, KRISTIN KAYLEE
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAYLEE
Last Name:MCCOLLOUGH
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 1:7730 N UNION BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4083
Mailing Address - Country:US
Mailing Address - Phone:386-479-0771
Mailing Address - Fax:
Practice Address - Street 1:7730 N UNION BLVD STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4083
Practice Address - Country:US
Practice Address - Phone:719-334-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician