Provider Demographics
NPI:1659000693
Name:CRYSTAL RIVER COUNSELING, LLC
Entity Type:Organization
Organization Name:CRYSTAL RIVER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MSW, LCSW
Authorized Official - Phone:303-900-7897
Mailing Address - Street 1:11992 RIDGE PKWY APT 304
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-5154
Mailing Address - Country:US
Mailing Address - Phone:303-900-7897
Mailing Address - Fax:
Practice Address - Street 1:11992 RIDGE PKWY APT 304
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-5154
Practice Address - Country:US
Practice Address - Phone:303-900-7897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty