Provider Demographics
NPI:1336644467
Name:WALTERS, CRYSTAL M (LMFT)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:M
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4251 KIPLING ST UNIT 430
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2970
Mailing Address - Country:US
Mailing Address - Phone:267-419-7817
Mailing Address - Fax:
Practice Address - Street 1:4251 KIPLING ST UNIT 430
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2970
Practice Address - Country:US
Practice Address - Phone:267-419-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001672106H00000X
PAMF000974106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist