Provider Demographics
NPI:1053047449
Name:PHELPS, KRISTEL MICHELE (MA, LPC, ATR)
Entity Type:Individual
Prefix:
First Name:KRISTEL
Middle Name:MICHELE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MA, LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 38TH ST STE 100E
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2624
Mailing Address - Country:US
Mailing Address - Phone:720-644-9133
Mailing Address - Fax:
Practice Address - Street 1:1179 MONROE DR APT B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2124
Practice Address - Country:US
Practice Address - Phone:719-502-0329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COATR.20-436221700000X
COLPC.0018720101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist