Provider Demographics
NPI:1649692195
Name:BRINKER, KRYSTEN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KRYSTEN
Middle Name:
Last Name:BRINKER
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 1:6402 ASHCROFT RD
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-9598
Mailing Address - Country:US
Mailing Address - Phone:970-397-9750
Mailing Address - Fax:
Practice Address - Street 1:1780 WESTLAND RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3322
Practice Address - Country:US
Practice Address - Phone:970-397-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-16
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019990101YP2500X
WYLPC-1467101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY143237100Medicaid