Provider Demographics
NPI:1134257090
Name:CANTRELL, KRISTEN FLEUR (PHD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:FLEUR
Last Name:CANTRELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3736 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2834
Mailing Address - Country:US
Mailing Address - Phone:303-912-3626
Mailing Address - Fax:
Practice Address - Street 1:9485 W COLFAX AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-3918
Practice Address - Country:US
Practice Address - Phone:303-432-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional