Healthcare Provider Details

I. General information

NPI: 1790643757
Provider Name (Legal Business Name): COLLEEN M KRINARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3539 THAXTON AVE SE
ALBUQUERQUE NM
87106-1628
US

IV. Provider business mailing address

PO BOX 25343
PRESCOTT VALLEY AZ
86312-5343
US

V. Phone/Fax

Practice location:
  • Phone: 541-707-7852
  • Fax:
Mailing address:
  • Phone: 541-707-7852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. COLLEEN KRINARD
Title or Position: OWNER
Credential: LCSW
Phone: 541-707-7852