Provider Demographics
NPI:1609484062
Name:MENZ, CRISTON A (LCSW)
Entity Type:Individual
Prefix:
First Name:CRISTON
Middle Name:A
Last Name:MENZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CRIS
Other - Middle Name:
Other - Last Name:MENZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1100 HOPKINS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-2421
Mailing Address - Country:US
Mailing Address - Phone:719-696-0910
Mailing Address - Fax:719-316-2753
Practice Address - Street 1:408 N MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1256
Practice Address - Country:US
Practice Address - Phone:719-423-8834
Practice Address - Fax:719-316-2753
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00099230591041C0700X
COCSW.099284541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14671305OtherCAQH