Healthcare Provider Details

I. General information

NPI: 1447038765
Provider Name (Legal Business Name): KRISTEN FOREMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 TERESA CT SE
RIO RANCHO NM
87124-2382
US

IV. Provider business mailing address

838 MACKILHAFFY DR
PATTERSON CA
95363-9111
US

V. Phone/Fax

Practice location:
  • Phone: 505-688-7083
  • Fax:
Mailing address:
  • Phone: 209-606-5547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2026-0079
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: