Provider Demographics
NPI:1659749299
Name:MICHELLE CHRASTIL COUNSELING LLC
Entity Type:Organization
Organization Name:MICHELLE CHRASTIL COUNSELING LLC
Other - Org Name:BLUE MOON COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CHRASTIL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-669-0893
Mailing Address - Street 1:5650 GREENWOOD PLAZA BLVD
Mailing Address - Street 2:SUITE 141
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5650 GREENWOOD PLAZA BLVD
Practice Address - Street 2:SUITE 141
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2307
Practice Address - Country:US
Practice Address - Phone:303-669-0893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0011936101Y00000X, 101YM0800X, 251S00000X
CO11191225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty