Provider Demographics
NPI:1255847737
Name:HEUN, KRYSTAL M
Entity Type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:M
Last Name:HEUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 QUAIL LAKE LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4651
Mailing Address - Country:US
Mailing Address - Phone:719-540-2152
Mailing Address - Fax:
Practice Address - Street 1:5812 WALSH PT APT 303
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1762
Practice Address - Country:US
Practice Address - Phone:719-679-7960
Practice Address - Fax:719-434-2085
Is Sole Proprietor?:No
Enumeration Date:2017-12-20
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician