Provider Demographics
NPI:1235822420
Name:PARKER, KRYSTA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:MARIE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6838 BACKCOUNTRY LOOP
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80927-4204
Mailing Address - Country:US
Mailing Address - Phone:702-683-0999
Mailing Address - Fax:
Practice Address - Street 1:6838 BACKCOUNTRY LOOP
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80927-4204
Practice Address - Country:US
Practice Address - Phone:702-683-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO099291981041C0700X
UT12278178-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical