Provider Demographics
NPI:1154063725
Name:STANSELL, KRISTY L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:L
Last Name:STANSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3528
Mailing Address - Country:US
Mailing Address - Phone:719-429-0629
Mailing Address - Fax:
Practice Address - Street 1:1369 FOREST LN
Practice Address - Street 2:
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-3528
Practice Address - Country:US
Practice Address - Phone:719-269-4250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0011707101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health