Provider Demographics
NPI:1881931392
Name:COUGHLIN, KRISTIN ANN (MA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ANN
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W TOMICHI AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2345
Mailing Address - Country:US
Mailing Address - Phone:720-381-2543
Mailing Address - Fax:
Practice Address - Street 1:123 W TOMICHI AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2345
Practice Address - Country:US
Practice Address - Phone:720-381-2543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0013795101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health