Provider Demographics
NPI:1427646991
Name:FOURNIER, KRISTEN BETH (MA, CAS)
Entity type:Individual
Prefix:MS
First Name:KRISTEN
Middle Name:BETH
Last Name:FOURNIER
Suffix:
Gender:F
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 S ROGERS DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1693
Mailing Address - Country:US
Mailing Address - Phone:518-521-5928
Mailing Address - Fax:
Practice Address - Street 1:595 S ROGERS DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-1693
Practice Address - Country:US
Practice Address - Phone:518-521-5928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2685191103TS0200X
CO324005103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool