Healthcare Provider Details

I. General information

NPI: 1548963630
Provider Name (Legal Business Name): KRYSTAL M IRIZARRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 INNOVATION DR STE 3A
FORT COLLINS CO
80525-7308
US

IV. Provider business mailing address

2002 BATTLECREEK DR
FORT COLLINS CO
80528-6213
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 970-818-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.00015155
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: