Healthcare Provider Details

I. General information

NPI: 1336519164
Provider Name (Legal Business Name): KRISTEN STINE M.ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 E 2ND ST
CASPER WY
82609-2062
US

IV. Provider business mailing address

14202 W EVANS CIR
LAKEWOOD CO
80228-5991
US

V. Phone/Fax

Practice location:
  • Phone: 484-643-8954
  • Fax:
Mailing address:
  • Phone: 484-643-8954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number11519166
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: