Basic Information
| Provider Information | |||||||||
| NPI: | 1922373695 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THORFINNSON | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 W 2ND ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827163333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076826699 | ||||||||
| FaxNumber: | 3076826698 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 W 2ND ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | GILLETTE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 827163333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076826699 | ||||||||
| FaxNumber: | 3076826698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2012 | ||||||||
| LastUpdateDate: | 03/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LPC-097 | WY | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.