Provider Demographics
NPI:1699473058
Name:O'KELLY, KRISTEN (LPCC, CAS)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:O'KELLY
Suffix:
Gender:F
Credentials:LPCC, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8919 FIELD ST UNIT 123
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4694
Mailing Address - Country:US
Mailing Address - Phone:720-375-0134
Mailing Address - Fax:
Practice Address - Street 1:3393 IRIS AVE STE 104
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1956
Practice Address - Country:US
Practice Address - Phone:303-736-9566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0998652101YA0400X
COLPCC.0020282101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)