Healthcare Provider Details

I. General information

NPI: 1134479900
Provider Name (Legal Business Name): KRISTEN THAYN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN BRADFORD

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 DAKOTA AVE
RANGELY CO
81648-2803
US

IV. Provider business mailing address

231 DAKOTA AVE
RANGELY CO
81648-2803
US

V. Phone/Fax

Practice location:
  • Phone: 435-419-0133
  • Fax: 970-548-4001
Mailing address:
  • Phone: 435-419-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0014546
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: