Provider Demographics
NPI:1487895058
Name:MIESEL, KRISTIN (PHD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:MIESEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 OPAL ST
Mailing Address - Street 2:UNIT 103
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-7306
Mailing Address - Country:US
Mailing Address - Phone:720-468-3870
Mailing Address - Fax:
Practice Address - Street 1:1090 OPAL ST
Practice Address - Street 2:UNIT 103
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7306
Practice Address - Country:US
Practice Address - Phone:720-468-3870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009095103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool