Provider Demographics
NPI:1881160489
Name:COVENTRY, KRISTY
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:COVENTRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 W DRAKE RD STE 6
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-2882
Mailing Address - Country:US
Mailing Address - Phone:970-281-5101
Mailing Address - Fax:
Practice Address - Street 1:363 W DRAKE RD STE 6
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2882
Practice Address - Country:US
Practice Address - Phone:970-281-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0020088101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional