Provider Demographics
NPI:1215206008
Name:SHINER, CRYSTA CARYLL (LCSW)
Entity Type:Individual
Prefix:
First Name:CRYSTA
Middle Name:CARYLL
Last Name:SHINER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRYSTA
Other - Middle Name:CARYLL
Other - Last Name:MORROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2223 POSHARD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1844
Mailing Address - Country:US
Mailing Address - Phone:800-562-5213
Mailing Address - Fax:
Practice Address - Street 1:6071 E WOODMEN RD STE 135
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2608
Practice Address - Country:US
Practice Address - Phone:719-572-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003901A101YM0800X, 1041C0700X
COCSW.099284501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty