Provider Demographics
NPI:1639877590
Name:BONNESEN, KRISTIN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BONNESEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 RIVA RIDGE DR APT B306
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6378
Mailing Address - Country:US
Mailing Address - Phone:614-218-5844
Mailing Address - Fax:
Practice Address - Street 1:1507 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4382
Practice Address - Country:US
Practice Address - Phone:720-282-9377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health