Individual
KIRSTEN JANE THOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW, LAC, MSW
Contact information
Practice address
700 CENTRE AVE, FORT COLLINS, CO 80526-2023
(970) 494-4200
Mailing address
4856 INNOVATION DR STE B, FORT COLLINS, CO 80525-5540
(970) 494-4200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
ACD.0000199
CO
1041C0700X
Clinical Social Worker
Primary
CSW.00001738
CO
Other
Enumeration date
10/22/2012
Last updated
05/31/2019
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