Healthcare Provider Details

I. General information

NPI: 1134528243
Provider Name (Legal Business Name): KIRSTEN TRYGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 10/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1432 GRAND AVENUE
GLENWOOD SPRINGS CO
81601
US

IV. Provider business mailing address

PO BOX 386
MINTURN CO
81645-0386
US

V. Phone/Fax

Practice location:
  • Phone: 617-755-8889
  • Fax: 970-827-4118
Mailing address:
  • Phone: 617-755-8889
  • Fax: 970-827-4118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACA.0007011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: