Provider Demographics
NPI:1104368935
Name:HALVORSON, KRISTIN (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:HALVORSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2790
Mailing Address - Country:US
Mailing Address - Phone:303-604-5439
Mailing Address - Fax:303-604-5439
Practice Address - Street 1:1400 DIXON AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2790
Practice Address - Country:US
Practice Address - Phone:303-604-5439
Practice Address - Fax:303-457-5658
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-23342103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst