Provider Demographics
NPI:1639621766
Name:VARIAN, KRISTEN ALISON (PSYD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALISON
Last Name:VARIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 N COLLEGE RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3484
Practice Address - Country:US
Practice Address - Phone:208-814-9100
Practice Address - Fax:208-814-9903
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043577A103T00000X
ID4061477103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist