Healthcare Provider Details

I. General information

NPI: 1598603888
Provider Name (Legal Business Name): KRISTIN MARGARET ETZEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 29TH ST STE 500
BOULDER CO
80303-2357
US

IV. Provider business mailing address

7408 SINGING HILLS DR UNIT K
BOULDER CO
80301-3768
US

V. Phone/Fax

Practice location:
  • Phone: 720-551-8074
  • Fax:
Mailing address:
  • Phone: 832-755-0772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0022985
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: