Basic Information
| Provider Information | |||||||||
| NPI: | 1043365745 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WULFSBERG | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WULFSBERG | ||||||||
| OtherFirstName: | KIRSTEN | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2465 SOUTH DOWNING ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | DENVER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 80210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037785774 | ||||||||
| FaxNumber: | 3037782436 | ||||||||
| Practice Location | |||||||||
| Address1: | 2465 SOUTH DOWNING ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | DENVER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 80210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037785774 | ||||||||
| FaxNumber: | 3037782436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2943 | CO | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.