Provider Demographics
NPI:1013992296
Name:KRYDER, CAROL A (LMFT SAP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KRYDER
Suffix:
Gender:F
Credentials:LMFT SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 POWDER PUFF DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-1615
Mailing Address - Country:US
Mailing Address - Phone:719-660-8844
Mailing Address - Fax:719-594-0116
Practice Address - Street 1:7610 N UNION BLVD
Practice Address - Street 2:SUITE 145
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3891
Practice Address - Country:US
Practice Address - Phone:719-660-8844
Practice Address - Fax:719-594-0116
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-11
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSAP 12243101YA0400X
COLMFT # 1028106H00000X
CAMFC # 25628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)